Basic Information
Provider Information
NPI: 1285362780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: HECTOR
MiddleName: I
NamePrefix: MR.
NameSuffix: JR.
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1695 MAIN ST FL 400
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011031063
CountryCode: US
TelephoneNumber: 4137395572
FaxNumber:  
Practice Location
Address1: 1695 MAIN ST FL 400
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011031063
CountryCode: US
TelephoneNumber: 4137395572
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/11/2022
LastUpdateDate: 08/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC1900X  Y Behavioral Health & Social Service ProvidersPsychologistCounseling

No ID Information.


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