Provider Demographics
NPI:1578302824
Name:HERNANDEZ, EMMANUEL DYLAN (LSW)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:DYLAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:EMMANUEL
Other - Middle Name:ROBERTO
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 50TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-7510
Mailing Address - Country:US
Mailing Address - Phone:551-655-5854
Mailing Address - Fax:
Practice Address - Street 1:10 50TH ST APT 1
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-7510
Practice Address - Country:US
Practice Address - Phone:551-655-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07109700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker