Provider Demographics
NPI:1619701984
Name:HERNANDEZ, OLIVIA KIMBERLEY
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KIMBERLEY
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 1:509 SCOTT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 S SCOTT AVE SUITE 100
Practice Address - Street 2:UNIT 2 C
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-286-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker