MEDICARE: MS. MACARENA FERNANDEZ MA CCC-SLP/BCBA

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	235Z00000X	Speech-Language Pathologist	06572	MD
2	103K00000X	Behavior Analyst	039	MD

General Provider Information

NPI Number	:	1033484522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MACARENA FERNANDEZ MA CCC-SLP/BCBA

Provider Business Mailing Address
First Line	:	750 AZALEA DR
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-2015
Country	:	US
Telephone Number	:	301-785-5334
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 COLUMBIA GATEWAY DR
Second Line	:	SUITE A
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2534
Country	:	US
Telephone Number	:	888-344-5977
Fax Number	:

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

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	07/14/2016

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