Provider Demographics
NPI:1548999170
Name:HERNANDEZ, MANUEL E (CBHCM-P0104969)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CBHCM-P0104969
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24252 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5176
Mailing Address - Country:US
Mailing Address - Phone:786-806-6022
Mailing Address - Fax:
Practice Address - Street 1:24252 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5176
Practice Address - Country:US
Practice Address - Phone:786-806-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM-P0104969104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker