Provider Demographics
NPI:1285974527
Name:HERNANDEZ, MARISELA (MSW 89932)
Entity type:Individual
Prefix:MRS
First Name:MARISELA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW 89932
Other - Prefix:
Other - First Name:MARISELA
Other - Middle Name:
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4628
Mailing Address - Country:US
Mailing Address - Phone:562-981-9392
Mailing Address - Fax:
Practice Address - Street 1:850 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4628
Practice Address - Country:US
Practice Address - Phone:562-981-9392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-24
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA89932101YM0800X
CA101YM0800X
CAASW89932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor