=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700634110
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILENE HERNANDEZ LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 COURTLANDT AVE APT 5A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-4385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-358-6445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 870 COURTLANDT AVE APT 5A
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-4385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-358-6445
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 097671
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------