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General NPI Number Information
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NPI Number | 1174025563
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Entity Type | Individual
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Provider Name | BEVERLY FERNANDEZ PSY. M, CCBT, CCTS-I
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 55 BROOK ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-2946
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Country | US
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Telephone | 678-462-5274
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Fax |
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Provider Business Mailing Address
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Address Line | 447 BROADWAY STE 443
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City | NEW YORK
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State | NY
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Zip | 10013-2562
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Country | US
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Telephone | 347-229-9907
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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