Individual
ISMAEL HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW, CADCI
Contact information
Practice address
704 ALBANY ST, CALDWELL, ID 83605-3501
(208) 454-5133
(208) 454-0749
Mailing address
626 SPRUCE CREEK DR, NAMPA, ID 83686-9716
(208) 250-2879
(208) 454-0749
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADCI 04-07-19
OR
104100000X
Social Worker
Primary
LSW-2652
ID
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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