MEDICARE: MR. ROBERT LLOYD HERNANDEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904017707	VA

General Provider Information

NPI Number	:	1891511408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LLOYD HERNANDEZ LCSW

Provider Business Mailing Address
First Line	:	7864 PATRIOTS LANDING PL
Second Line	:
City	:	QUINTON
State	:	VA
Zip	:	23141-1645
Country	:	US
Telephone Number	:	804-731-5494
Fax Number	:

Provider Business Practice Location Address
First Line	:	16035 CONTINENTAL BLVD
Second Line	:
City	:	SOUTH CHESTERFIELD
State	:	VA
Zip	:	23834-5900
Country	:	US
Telephone Number	:	804-731-5494
Fax Number	:	804-479-8219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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