Healthcare Provider Details

I. General information

NPI: 1134600406
Provider Name (Legal Business Name): JULIA HERNANDEZ NIERENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 7TH ST E
SAINT PAUL MN
55106-5070
US

IV. Provider business mailing address

797 7TH ST E
SAINT PAUL MN
55106-5070
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-4200
  • Fax: 612-887-1430
Mailing address:
  • Phone: 651-379-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: