Healthcare Provider Details

I. General information

NPI: 1841107190
Provider Name (Legal Business Name): DENISE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1059 BRIDGE ST
PHILADELPHIA PA
19124-1824
US

IV. Provider business mailing address

233 STATION SQUARE BLVD
LANSDALE PA
19446-3989
US

V. Phone/Fax

Practice location:
  • Phone: 267-225-7180
  • Fax:
Mailing address:
  • Phone: 267-575-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBH008443
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: