Provider Demographics
NPI:1043432784
Name:FERNANDES, DELLA (LICENSED MFT)
Entity Type:Individual
Prefix:MS
First Name:DELLA
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PRIMROSE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4091
Mailing Address - Country:US
Mailing Address - Phone:650-490-3120
Mailing Address - Fax:
Practice Address - Street 1:1204 BURLINGAME AVE STE 5
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4139
Practice Address - Country:US
Practice Address - Phone:925-365-6968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52312101YM0800X
CAMFC50734106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health