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General NPI Number Information
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NPI Number | 1144931411
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Entity Type | Individual
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Provider Name | JESSICA FERNANDES MSW, RCSWI
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Gender | Female
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 8198 S JOG RD STE 201
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-6903
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Country | US
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Telephone | 561-810-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 EUROPA DR APT E
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-2147
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Country | US
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Telephone | 908-499-7621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15639
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License Number State | FL
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