Provider Demographics
NPI:1033481882
Name:FERNANDEZ, JOANNA (BCBA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N HOLLYWOOD WAY
Mailing Address - Street 2:#304
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1055
Mailing Address - Country:US
Mailing Address - Phone:866-278-5011
Mailing Address - Fax:
Practice Address - Street 1:2550 N HOLLYWOOD WAY
Practice Address - Street 2:#304
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1055
Practice Address - Country:US
Practice Address - Phone:866-278-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst