Provider Demographics
NPI:1770017493
Name:HERNANDEZ, YASMIANY LUCIA (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:YASMIANY
Middle Name:LUCIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ELM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2935
Mailing Address - Country:US
Mailing Address - Phone:786-718-5701
Mailing Address - Fax:
Practice Address - Street 1:240 ELM ST FL 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2935
Practice Address - Country:US
Practice Address - Phone:786-718-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA1-18-30970103K00000X
1-18-30970103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831896067Medicaid