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General NPI Number Information
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NPI Number | 1700532926
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Entity Type | Individual
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Provider Name | LYANNE JANETTE HERNANDEZ CLINICAL SOCIAL WORK
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Gender | Female
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 1607 AVE PONCE DE LEON STE 105
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City | SAN JUAN
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State | PR
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Zip | 00909-1812
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Country | US
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Telephone | 787-925-1866
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE PARIS 243 PMB 1197
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-310-5224
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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 | 15194
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License Number State | PR
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