Healthcare Provider Details

I. General information

NPI: 1982398236
Provider Name (Legal Business Name): CARMEN P FERNANDEZ MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 ROUTE 33 STE 408
HAMILTON NJ
08690-1700
US

IV. Provider business mailing address

660 TENNENT RD STE 104
MANALAPAN NJ
07726-3163
US

V. Phone/Fax

Practice location:
  • Phone: 732-851-4808
  • Fax:
Mailing address:
  • Phone: 732-851-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00981900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: