Provider Demographics
NPI:1285381699
Name:HERNANDEZ, MEGAN BREE (MFT-LP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:BREE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MFT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 1ST AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4313
Mailing Address - Country:US
Mailing Address - Phone:646-642-4577
Mailing Address - Fax:
Practice Address - Street 1:2065 1ST AVE APT 3F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4313
Practice Address - Country:US
Practice Address - Phone:646-642-4577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist