Provider Demographics
NPI:1134664600
Name:FERNANDEZ, ADA (CBHCMS/RBT)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CBHCMS/RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1802
Mailing Address - Country:US
Mailing Address - Phone:786-614-8942
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:786-614-8942
Practice Address - Fax:786-483-8142
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100019104100000X
FLRBT-20-148857106S00000X
171M00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No253Z00000XAgenciesIn Home Supportive Care