MEDICARE: ADELINA HERNANDEZ

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	44SL06947800	NJ
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932913498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELINA HERNANDEZ

Provider Business Mailing Address
First Line	:	PO BOX 80815
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91716-8420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 PASSAIC AVE STE 200
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-3526
Country	:	US
Telephone Number	:	800-413-8020
Fax Number	:

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

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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Directions to “ ADELINA HERNANDEZ ” Practice Location

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