Provider Demographics
NPI:1043022130
Name:HERNANDEZ, DEBORAH IVETTE (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:IVETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1478
Mailing Address - Country:US
Mailing Address - Phone:787-212-4935
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER PLAZA 740 AVE HOSTOS
Practice Address - Street 2:SUITE 202
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-212-4935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8166103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical