Provider Demographics
NPI:1124736236
Name:HERNANDEZ, HEATHER P (LMFT, CCLS)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:P
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMFT, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275-220 ROUTE 10 EAST
Mailing Address - Street 2:SUITE #252
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275-220 ROUTE 10 EAST
Practice Address - Street 2:SUITE #252
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-0787
Practice Address - Country:US
Practice Address - Phone:973-970-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100208000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist