Provider Demographics
NPI:1285348581
Name:HERNANDEZ, TRUCLY KIM (LSW)
Entity type:Individual
Prefix:
First Name:TRUCLY
Middle Name:KIM
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7760
Mailing Address - Country:US
Mailing Address - Phone:862-202-9980
Mailing Address - Fax:
Practice Address - Street 1:773 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2528
Practice Address - Country:US
Practice Address - Phone:908-228-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06791700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker