Provider Demographics
NPI:1992497572
Name:HERNANDEZ, MICHELLE A (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 SW 67TH AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5819
Mailing Address - Country:US
Mailing Address - Phone:305-370-5781
Mailing Address - Fax:
Practice Address - Street 1:815 NW 57TH AVE STE 305B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2385
Practice Address - Country:US
Practice Address - Phone:888-587-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH10819OtherTHE FLORIDA DEPARTMENT OF HEALTH