Healthcare Provider Details

I. General information

NPI: 1396677399
Provider Name (Legal Business Name): MATTHEW FERNANDEZ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 READING RD
CINCINNATI OH
45237-6107
US

IV. Provider business mailing address

3254 NIAGARA ST
CINCINNATI OH
45251-2141
US

V. Phone/Fax

Practice location:
  • Phone: 855-577-7284
  • Fax:
Mailing address:
  • Phone: 513-816-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: