MEDICARE: CRISTOBAL R. FERNANDEZ LCPC

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
2	101YM0800X	Mental Health Counselor	15243	MD

General Provider Information

NPI Number	:	1467246017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTOBAL R. FERNANDEZ LCPC

Provider Business Mailing Address
First Line	:	9528 DUFFER WAY
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-1312
Country	:	US
Telephone Number	:	202-316-0347
Fax Number	:

Provider Business Practice Location Address
First Line	:	9528 DUFFER WAY
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886-1312
Country	:	US
Telephone Number	:	202-316-0347
Fax Number	:

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

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/28/2025

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