Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LISAC 10433 | AZ |
Y | 102L00000X | Psychologist | 3867 | AZ |
Y | 103T00000X | Psychologist | 3867 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LISAC-10433 | AZ |
NPI | 1083929442 |
---|---|
Provider Name | Dr. Patricia Marie Hernandez |
First Address | Buckeye, AZ 85326-7842 |
Second Address | Scottsdale, AZ 85258-1298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 10/08/2010 |