Healthcare Provider Details

I. General information

NPI: 1992022347
Provider Name (Legal Business Name): IVELIS FERNANDEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MECHANIC ST
EASTHAMPTON MA
01027-1562
US

IV. Provider business mailing address

11 LINDEN ST
HOLYOKE MA
01040-4115
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax: 413-538-5169
Mailing address:
  • Phone: 413-540-1234
  • Fax: 413-538-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: