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NPI Code Detail

MEDICARE: DR. ANNIE FERNANDEZ PSYD

MEDICARE: DR. ANNIE FERNANDEZ PSYD
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
1103TC0700XClinical Psychologist071-009568IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1071-009568OTHERILLICENSE

General Provider Information

NPI Number : 1083047120
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNIE FERNANDEZ PSYD
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3232 LAKE AVE STE 330
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1085
Country : US
Telephone Number : 847-318-9300
Fax Number : 847-723-9441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2013
Last Update Date : 07/05/2023

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Directions to “ DR. ANNIE FERNANDEZ PSYD” Practice Location

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