Healthcare Provider Details

I. General information

NPI: 1891646675
Provider Name (Legal Business Name): VICTOR HERNANDEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 INDIAN SCHOOL RD NE # 212
ALBUQUERQUE NM
87106-2653
US

IV. Provider business mailing address

7851 LATIR MESA RD NW
ALBUQUERQUE NM
87114-1690
US

V. Phone/Fax

Practice location:
  • Phone: 505-225-1068
  • Fax:
Mailing address:
  • Phone: 505-850-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: