Healthcare Provider Details

I. General information

NPI: 1386318632
Provider Name (Legal Business Name): EDGAR HERNANDEZ LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

IV. Provider business mailing address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9501
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax: 304-429-7532
Mailing address:
  • Phone: 304-429-6741
  • Fax: 304-429-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608759
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946785
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: