Healthcare Provider Details

I. General information

NPI: 1265678965
Provider Name (Legal Business Name): MARY ROSE FERNANDEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ROSE FERNANDEZ LMHC

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CEDAR ST
BROOKLYN NY
11221-3253
US

IV. Provider business mailing address

48 CEDAR ST
BROOKLYN NY
11221-3253
US

V. Phone/Fax

Practice location:
  • Phone: 347-330-9378
  • Fax:
Mailing address:
  • Phone: 347-330-9378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number004349-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: