Individual
TIMOTHY HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC I
Contact information
Practice address
295 SCONTICUT NECK RD, FAIRHAVEN, MA 02719-1506
(508) 863-6733
Mailing address
295 SCONTICUT NECK RD, FAIRHAVEN, MA 02719-1506
(508) 863-6733
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11680
MA
Other
Enumeration date
03/25/2016
Last updated
03/25/2016
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