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NPI Code Detail

MEDICARE: ALFONSO HERNANDEZ LCSW

MEDICARE: ALFONSO 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
1106H00000XMarriage & Family TherapistLCS20714CA

General Provider Information

NPI Number : 1942283148
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFONSO HERNANDEZ LCSW
Provider Business Mailing Address
First Line : 737 W CHILDS AVE
Second Line :
City : MERCED
State : CA
Zip : 95340-6805
Country : US
Telephone Number : 209-383-1848
Fax Number : 209-384-3966
Provider Business Practice Location Address
First Line : 1717 LAS VEGAS ST
Second Line :
City : MODESTO
State : CA
Zip : 95358-5500
Country : US
Telephone Number : 209-576-4200
Fax Number : 209-556-5047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 07/08/2007

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Directions to “ ALFONSO HERNANDEZ LCSW” Practice Location

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