Provider Demographics
NPI:1982412755
Name:HERNANDEZ DELGADO, FREDY (RBT)
Entity type:Individual
Prefix:MR
First Name:FREDY
Middle Name:
Last Name:HERNANDEZ DELGADO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 80 OAK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:786-992-9817
Mailing Address - Fax:855-632-2877
Practice Address - Street 1:8310 RIVERS AVENUE
Practice Address - Street 2:SUITE D
Practice Address - City:N. CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-588-5677
Practice Address - Fax:855-632-2877
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-358966106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician