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General NPI Number Information
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NPI Number | 1245941814
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Entity Type | Individual
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Provider Name | TESSA NICOLE HERNANDEZ MSW
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Gender | Female
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 5190 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90805-6510
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Country | US
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Telephone | 562-428-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 243 WHITTLEY AVE # 1995
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City | AVALON
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State | CA
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Zip | 90704-3189
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Country | US
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Telephone | 310-387-6206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 112506
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License Number State | CA
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