Provider Demographics
NPI:1992282628
Name:HERNANDEZ, CARLOS A (MSW)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 W 56TH ST APT 1316
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6902
Mailing Address - Country:US
Mailing Address - Phone:170-457-9363
Mailing Address - Fax:
Practice Address - Street 1:1990 W 56TH ST APT 1316
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6902
Practice Address - Country:US
Practice Address - Phone:170-457-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical