Provider Demographics
NPI:1699082628
Name:HERNANDEZ, MARYLIN LYNETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARYLIN
Middle Name:LYNETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CRESCENT ST APT D3
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3377
Mailing Address - Country:US
Mailing Address - Phone:718-204-7695
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVE & 27TH ST.
Practice Address - Street 2:BELLEVUE HOSPITAL CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-562-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038413-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical