Provider Demographics
NPI:1235942590
Name:SIERRA HERNANDEZ, IRIS MONSERRAT
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MONSERRAT
Last Name:SIERRA HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 REEDSFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-9097
Mailing Address - Country:US
Mailing Address - Phone:910-305-4445
Mailing Address - Fax:
Practice Address - Street 1:340A NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2424
Practice Address - Country:US
Practice Address - Phone:910-261-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25404154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician