Provider Demographics
NPI:1194480079
Name:CARRILLO, HAYDEE HERNANDEZ (LMSW)
Entity type:Individual
Prefix:
First Name:HAYDEE
Middle Name:HERNANDEZ
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8007
Mailing Address - Country:US
Mailing Address - Phone:956-645-7728
Mailing Address - Fax:
Practice Address - Street 1:8709 MARTINIQUE DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8007
Practice Address - Country:US
Practice Address - Phone:956-645-7728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105302104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty