Healthcare Provider Details

I. General information

NPI: 1942533021
Provider Name (Legal Business Name): KENYA FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVA K FERNANDEZ

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MADISON AVE RM 501
NEW YORK NY
10016-0827
US

IV. Provider business mailing address

364 S 1ST ST APT 14
BROOKLYN NY
11211-4726
US

V. Phone/Fax

Practice location:
  • Phone: 516-900-3072
  • Fax:
Mailing address:
  • Phone: 516-900-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: