Provider Demographics
NPI:1053194563
Name:HERNANDEZ ESPINOZA, JENNIFER JULIETH (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JULIETH
Last Name:HERNANDEZ ESPINOZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2213
Mailing Address - Country:US
Mailing Address - Phone:914-413-2441
Mailing Address - Fax:
Practice Address - Street 1:47 LONG LOTS RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3828
Practice Address - Country:US
Practice Address - Phone:203-221-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119975104100000X
CT8457104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker