Provider Demographics
NPI:1215245279
Name:HERNANDEZ, AMY MARIE (LBSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S US HIGHWAY 281
Mailing Address - Street 2:#25
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9650
Mailing Address - Country:US
Mailing Address - Phone:956-483-5380
Mailing Address - Fax:956-973-0413
Practice Address - Street 1:1010 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6600
Practice Address - Country:US
Practice Address - Phone:956-463-4823
Practice Address - Fax:956-973-0413
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51558171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator