Healthcare Provider Details

I. General information

NPI: 1558486563
Provider Name (Legal Business Name): JENNIFER FERNANDEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MOUNTAIN BLVD
WERNERSVILLE PA
19565-9219
US

IV. Provider business mailing address

1171 MARCUS DR
POTTSTOWN PA
19465-1013
US

V. Phone/Fax

Practice location:
  • Phone: 570-561-2982
  • Fax:
Mailing address:
  • Phone: 267-977-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: