Healthcare Provider Details

I. General information

NPI: 1144762725
Provider Name (Legal Business Name): SHIRLEY HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143A SMITH ST # 177
PERTH AMBOY NJ
08861-4345
US

IV. Provider business mailing address

143A SMITH ST # 177
PERTH AMBOY NJ
08861-4345
US

V. Phone/Fax

Practice location:
  • Phone: 732-781-0890
  • Fax: 732-781-0890
Mailing address:
  • Phone: 732-781-0890
  • Fax: 732-781-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05962200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: