Provider Demographics
NPI:1396149209
Name:HERNANDEZ, MEGHANN (M ED,BSL)
Entity type:Individual
Prefix:
First Name:MEGHANN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:M ED,BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 COURSEY RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075
Mailing Address - Country:US
Mailing Address - Phone:215-801-6000
Mailing Address - Fax:
Practice Address - Street 1:507 COURSEY RD
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-1508
Practice Address - Country:US
Practice Address - Phone:215-801-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002514103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst