Provider Demographics
NPI:1063239697
Name:HERNANDEZ, NELSON ABDIEL (MSW)
Entity type:Individual
Prefix:MISS
First Name:NELSON
Middle Name:ABDIEL
Last Name:HERNANDEZ
Suffix:
Gender:X
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-1067
Mailing Address - Country:US
Mailing Address - Phone:787-546-1805
Mailing Address - Fax:
Practice Address - Street 1:URB LAGO ALTO
Practice Address - Street 2:CALLE CARITE 130
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00796-3918
Practice Address - Country:US
Practice Address - Phone:787-737-2311
Practice Address - Fax:787-737-2377
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR168401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical