Basic Information
| Provider Information | |||||||||
| NPI: | 1891380754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 AVENUE D APT 10C | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100097014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6462836542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4941 BROADWAY LOWR LEVEL | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100342303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129421460 | ||||||||
| FaxNumber: | 2125672019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2021 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 100483 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.