Provider Demographics
NPI:1003844093
Name:FERNANDEZ, JOHNELL (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHNELL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9918 GAZELLE FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4326
Mailing Address - Country:US
Mailing Address - Phone:210-517-0070
Mailing Address - Fax:832-698-9531
Practice Address - Street 1:9918 GAZELLE FRST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4326
Practice Address - Country:US
Practice Address - Phone:210-517-0070
Practice Address - Fax:832-698-9531
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X, 385H00000X, 385HR2060X, 385HR2065X, 251B00000X
TX30306104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child