Provider Demographics
NPI:1275424293
Name:HERNANDEZ, TIEFA NICHOLE (LSW)
Entity type:Individual
Prefix:
First Name:TIEFA
Middle Name:NICHOLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 TULAROSA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4058
Mailing Address - Country:US
Mailing Address - Phone:765-202-4019
Mailing Address - Fax:
Practice Address - Street 1:3720 TULAROSA DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4058
Practice Address - Country:US
Practice Address - Phone:765-202-4019
Practice Address - Fax:765-202-4019
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3301025A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker