Provider Demographics
NPI:1164098166
Name:FERNANDES, JUANITA J
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:J
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CEDAR MEADOWS DR W
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5885
Mailing Address - Country:US
Mailing Address - Phone:401-641-9603
Mailing Address - Fax:
Practice Address - Street 1:170 PLEASANT ST STE 100
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3015
Practice Address - Country:US
Practice Address - Phone:774-294-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst