Doctor Name: | TIMOTHY HERNANDEZ |
NPI Number: | 1336501691 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC I |
License Number: | 11680 |
Business Practice Address: | 295 Sconticut Neck Rd Fairhaven, MA - 027191506 |
Business Phone Number: | 5088636733 |
Business Fax Number: | |
Mailing Address: | 295 Sconticut Neck Rd, FAIRHAVEN |
State: | MA |
Postal Code: | 027191506 |
Phone Number: | 5088636733 |
Fax Number: | |
NPI Enumeration Date: | 03/25/2016 |
NPI Last Update Date: | 03/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 11680 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |