Provider Demographics
NPI:1962557546
Name:HERNANDEZ, DONNA EVANS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:EVANS
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5235 W WOODMILL DRIVE SUITES 47148
Mailing Address - Street 2:WOODMILL CORPORATE CENTER
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-995-1680
Mailing Address - Fax:302-995-1790
Practice Address - Street 1:5235 W WOODMILL DRIVE SUITES 47148
Practice Address - Street 2:WOODMILL CORPORATE CENTER
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-995-1680
Practice Address - Fax:302-995-1790
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100005121041C0700X
NY06509211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000512C89Medicare ID - Type Unspecified