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General NPI Number Information
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NPI Number | 1386005577
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Entity Type | Individual
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Provider Name | KRISTEN HERNANDEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 09/01/2017
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Provider Practice Location Address
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Address Line | 3900 LEGACY PARK BLVD NW STE D100
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City | KENNESAW
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State | GA
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Zip | 30144-7322
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Country | US
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Telephone | 847-421-7112
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Fax |
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Provider Business Mailing Address
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Address Line | 408 E OAKTON ST
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4718
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Country | US
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Telephone |
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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 | 149.016929
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License Number State | IL
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