Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 5TH AVE SUITE 110
TROY NY
12180-3482
US

IV. Provider business mailing address

2001 5TH AVE SUITE 110
TROY NY
12180-3482
US

V. Phone/Fax

Practice location:
  • Phone: 518-687-1960
  • Fax: 518-687-1970
Mailing address:
  • Phone: 518-687-1960
  • Fax: 518-687-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72098960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: