MEDICARE: EDWARD 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
1	103TC1900X	Counseling Psychologist	019609	NY

General Provider Information

NPI Number	:	1205223278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD FERNANDEZ, PSYD

Provider Business Mailing Address
First Line	:	114 E 90TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1543
Country	:	US
Telephone Number	:	917-686-8020
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 E 90TH ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1543
Country	:	US
Telephone Number	:	917-686-8020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD FERNANDEZ
Credential	:
Telephone Number	:	917-686-8020

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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