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General NPI Number Information
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NPI Number | 1972358943
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Entity Type | Individual
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Provider Name | ANTONIO DEJESUS FERNANDEZ JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 2219 N HOWARD ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19133-3727
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Country | US
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Telephone | 267-880-9917
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 DORCAS ST
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5403
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Country | US
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Telephone | 267-880-9917
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC016692
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License Number State | PA
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