Provider Demographics
NPI:1730524018
Name:HERNANDEZ, LORENA MARGARITA (MA, LLP)
Entity type:Individual
Prefix:MS
First Name:LORENA
Middle Name:MARGARITA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:MS
Other - First Name:LORENA
Other - Middle Name:MARGARITA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:10 PETERBORO
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-831-3160
Mailing Address - Fax:313-963-0103
Practice Address - Street 1:10 PETERBORO
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-831-3160
Practice Address - Fax:313-963-0103
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist