Provider Demographics
NPI:1144974643
Name:HERNANDEZ, CAROL VANESSA
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:VANESSA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 SPICEWOOD SPRINGS RD APT 2103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8577
Mailing Address - Country:US
Mailing Address - Phone:512-265-1282
Mailing Address - Fax:
Practice Address - Street 1:4411 SPICEWOOD SPRINGS RD APT 2103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8577
Practice Address - Country:US
Practice Address - Phone:512-265-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker