Provider Demographics
NPI:1174025563
Name:FERNANDEZ, BEVERLY (PSY M, CCBT, CCTS-I)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PSY M, CCBT, CCTS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 BROADWAY STE 443
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2562
Mailing Address - Country:US
Mailing Address - Phone:347-229-9907
Mailing Address - Fax:
Practice Address - Street 1:55 BROOK ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2946
Practice Address - Country:US
Practice Address - Phone:678-462-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator