Provider Demographics
NPI:1972818771
Name:HERNANDEZ, ELAINA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELAINA
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3202 CAROLINA LILY ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6709
Mailing Address - Country:US
Mailing Address - Phone:919-386-9852
Mailing Address - Fax:919-651-9132
Practice Address - Street 1:1140 KILDAIRE FARM RD # 202-5
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4562
Practice Address - Country:US
Practice Address - Phone:919-386-9852
Practice Address - Fax:919-651-3718
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0815071041C0700X
NCC0114931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400099199Medicare UPIN