Provider Demographics
NPI:1366573347
Name:JOSEPH-HERNANDEZ, LYDIA MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:MARIE
Last Name:JOSEPH-HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:MARIE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:8617 WORTHINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775
Mailing Address - Country:US
Mailing Address - Phone:626-327-6327
Mailing Address - Fax:
Practice Address - Street 1:2010 ZONAL
Practice Address - Street 2:3-P-61
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-6767
Practice Address - Fax:323-226-3902
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19896103T00000X
CAPSY 19896103TC0700X
CAMFC 31916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist