Provider Demographics
NPI:1144762725
Name:HERNANDEZ, SHIRLEY (LMSW)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3482
Mailing Address - Country:US
Mailing Address - Phone:518-687-1960
Mailing Address - Fax:518-687-1970
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3482
Practice Address - Country:US
Practice Address - Phone:518-687-1960
Practice Address - Fax:518-687-1970
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720989601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical