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General NPI Number Information
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NPI Number | 1235480484
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Entity Type | Individual
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Provider Name | YESENIA FERMIN MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 525 BOULEVARD SUITE 2 SUITE 2
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City | KENILWORTH
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State | NJ
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Zip | 07033
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Country | US
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Telephone | 908-652-7061
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 2562
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City | WESTFIELD
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State | NJ
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Zip | 07091
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Country | US
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Telephone | 908-652-7061
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05517500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | NJ44SC05S17500
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License Number State | NJ
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