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General NPI Number Information
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NPI Number | 1205223278
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Entity Type | Organization
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Legal Business Name | EDWARD FERNANDEZ, PSYD
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 114 E 90TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10128-1543
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Country | US
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Telephone | 917-686-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 114 E 90TH ST APT 1A
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City | NEW YORK
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State | NY
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Zip | 10128-1543
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Country | US
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Telephone | 917-686-8020
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWARD FERNANDEZ
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Credential |
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Telephone | 917-686-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 019609
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License Number State | NY
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