Provider Demographics
NPI:1093355786
Name:FERNANDEZ, MAYRELY JANINE (LMHC)
Entity Type:Individual
Prefix:
First Name:MAYRELY
Middle Name:JANINE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MAYRELY
Other - Middle Name:JANINE
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19770 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8100
Mailing Address - Country:US
Mailing Address - Phone:786-552-2368
Mailing Address - Fax:
Practice Address - Street 1:2300 W 84TH ST STE 409
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5780
Practice Address - Country:US
Practice Address - Phone:305-827-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12351101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health