Basic Information
| Provider Information | |||||||||
| NPI: | 1073775268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MARGARITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.H.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 TOWN LINE RD | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573702 | ||||||||
| FaxNumber: | 8607573725 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 TOWN LINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WETHERSFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061094352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607573702 | ||||||||
| FaxNumber: | 8607573725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2008 | ||||||||
| LastUpdateDate: | 03/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 002171 | CT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.