Provider Demographics
NPI:1023360054
Name:FERNANDEZ, ANTONIO (MSW)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1348
Mailing Address - Country:US
Mailing Address - Phone:787-737-7636
Mailing Address - Fax:787-737-7636
Practice Address - Street 1:CALLE SANTIAGO NORTE
Practice Address - Street 2:#53 (ALTOS)
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-7636
Practice Address - Fax:787-737-7636
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR58091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical