MEDICARE: MAYRELY JANINE FERNANDEZ LMHC

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	101YM0800X	Mental Health Counselor	MH12351	FL

General Provider Information

NPI Number	:	1093355786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRELY JANINE FERNANDEZ LMHC

Provider Business Mailing Address
First Line	:	19770 CYPRESS CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8100
Country	:	US
Telephone Number	:	786-552-2368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 W 84TH ST STE 409
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5780
Country	:	US
Telephone Number	:	305-827-3252
Fax Number	:

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

Provider Enumeration Date	:	01/09/2020
Last Update Date	:	04/15/2020

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