Healthcare Provider Details

I. General information

NPI: 1538649074
Provider Name (Legal Business Name): ERICA L HERNANDEZ, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGH ST STE C1
EUGENE OR
97401-4192
US

IV. Provider business mailing address

1400 HIGH ST STE C1
EUGENE OR
97401-4192
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-7010
  • Fax: 541-343-1044
Mailing address:
  • Phone: 541-345-7010
  • Fax: 541-343-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3688
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier50060860
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MRS. ERICA L HERNANDEZ
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 541-345-7010