Healthcare Provider Details

I. General information

NPI: 1982418752
Provider Name (Legal Business Name): FERNANDEZ THERAPY GROUP LICENSED CLINICAL SOCIAL WORKER, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARAMOUNT BLVD STE 202
DOWNEY CA
90241-3351
US

IV. Provider business mailing address

10810 PARAMOUNT BLVD STE 202
DOWNEY CA
90241-3351
US

V. Phone/Fax

Practice location:
  • Phone: 909-248-3513
  • Fax:
Mailing address:
  • Phone: 909-248-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RONNIE FERNANDEZ
Title or Position: CEO
Credential: LCSW
Phone: 323-793-3595