Provider Demographics
NPI:1043685258
Name:HERNANDEZ DE MORISSETTE, OREIDA (MASTERS MENTAL HEALT)
Entity type:Individual
Prefix:MRS
First Name:OREIDA
Middle Name:
Last Name:HERNANDEZ DE MORISSETTE
Suffix:
Gender:F
Credentials:MASTERS MENTAL HEALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 E. OAK STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744
Mailing Address - Country:US
Mailing Address - Phone:407-483-9520
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:809 E. OAK STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-483-9520
Practice Address - Fax:407-483-9551
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010460000Medicaid