Provider Demographics
NPI:1538611512
Name:HERNANDEZ, ALEXANDRA (MSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CALLE MADAGASCAR
Mailing Address - Street 2:URB. PALMA ROYALE
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-3456
Mailing Address - Country:US
Mailing Address - Phone:787-218-8980
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE 2
Practice Address - Street 2:SUITE 520
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-248-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05-20-5665101YA0400X
PR11194104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)