1689816209 NPI number — MRS. CYNTHIA JUNE HERNANZ L.C.S.W.

Table of content: MRS. CYNTHIA JUNE HERNANZ L.C.S.W. (NPI 1689816209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689816209 NPI number — MRS. CYNTHIA JUNE HERNANZ L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANZ
Provider First Name:
CYNTHIA
Provider Middle Name:
JUNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRITTS
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689816209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37940-1776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-313-5683
Provider Business Mailing Address Fax Number:
865-691-7364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CENTER PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922-2124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-313-5683
Provider Business Practice Location Address Fax Number:
865-691-7364
Provider Enumeration Date:
03/27/2009

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: 1041C0700X , with the licence number:  5109 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 9237 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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