Basic Information
Provider Information
NPI: 1003007881
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: ALFREDO
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: M.S., LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11040 N KENDALL DR STE C-100
Address2:  
City: MIAMI
State: FL
PostalCode: 331761272
CountryCode: US
TelephoneNumber: 3052705305
FaxNumber: 3052705306
Practice Location
Address1: 11040 N KENDALL DR STE C-100
Address2:  
City: MIAMI
State: FL
PostalCode: 331761272
CountryCode: US
TelephoneNumber: 3052705305
FaxNumber: 3052705306
Other Information
ProviderEnumerationDate: 08/06/2007
LastUpdateDate: 04/17/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH9171FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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