MEDICARE: MS. BEVERLY FERNANDEZ PSY. M, CCBT, CCTS-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1174025563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY FERNANDEZ PSY. M, CCBT, CCTS-I

Provider Business Mailing Address
First Line	:	447 BROADWAY STE 443
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-2562
Country	:	US
Telephone Number	:	347-229-9907
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 BROOK ST
Second Line	:
City	:	WOODBRIDGE
State	:	NJ
Zip	:	07095-2946
Country	:	US
Telephone Number	:	678-462-5274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	05/16/2026

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