1891316345 NPI number — SANDYBEL AILE HERNANDEZ LCSW, LPHA

Table of content: SANDYBEL AILE HERNANDEZ LCSW, LPHA (NPI 1891316345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891316345 NPI number — SANDYBEL AILE HERNANDEZ LCSW, LPHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
SANDYBEL
Provider Middle Name:
AILE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LPHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891316345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1752 CAPITAL STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60124-7896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-695-3680
Provider Business Mailing Address Fax Number:
847-695-4552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1752 CAPITAL STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60124-7896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-695-3680
Provider Business Practice Location Address Fax Number:
847-695-4552
Provider Enumeration Date:
05/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149028971 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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