Provider Demographics
NPI:1336995661
Name:HERNANDEZ, TIFFANY SHANELLE (MHC-LP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHANELLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10235 64TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1545
Mailing Address - Country:US
Mailing Address - Phone:347-463-8066
Mailing Address - Fax:
Practice Address - Street 1:10235 64TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1545
Practice Address - Country:US
Practice Address - Phone:347-463-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health