MEDICARE: MR. ANTHONY FERNANDEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023181377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY FERNANDEZ LCSW

Provider Business Mailing Address
First Line	:	6390 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3517
Country	:	US
Telephone Number	:	520-284-7949
Fax Number	:

Provider Business Practice Location Address
First Line	:	6390 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3517
Country	:	US
Telephone Number	:	520-284-7949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/25/2024

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