Provider Demographics
NPI:1023626587
Name:HERNANDEZ, BETTY BEATRIZ
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:BEATRIZ
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 20TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-3200
Mailing Address - Country:US
Mailing Address - Phone:239-200-9240
Mailing Address - Fax:
Practice Address - Street 1:4204 20TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-3200
Practice Address - Country:US
Practice Address - Phone:239-200-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician