Provider Demographics
NPI:1750261897
Name:HERNANDEZ, JACQUELENE ROBERTA (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELENE
Middle Name:ROBERTA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 SANTA ANA AVE APT D203
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6406
Mailing Address - Country:US
Mailing Address - Phone:559-936-9424
Mailing Address - Fax:
Practice Address - Street 1:1765 SANTA ANA AVE APT D203
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6406
Practice Address - Country:US
Practice Address - Phone:559-936-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty