Provider Demographics
NPI:1083208144
Name:FERNANDEZ, JOSE EMILIO (CBHCM)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EMILIO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CORAL WAY APT 1411
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3240
Mailing Address - Country:US
Mailing Address - Phone:786-457-2547
Mailing Address - Fax:
Practice Address - Street 1:1710 NW 7TH ST STE 7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3520
Practice Address - Country:US
Practice Address - Phone:786-464-0353
Practice Address - Fax:786-483-8142
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator