Provider Demographics
NPI:1225229420
Name:FERNANDES, CHRIS L (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:L
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AUCOOT RD
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-2402
Mailing Address - Country:US
Mailing Address - Phone:508-758-8085
Mailing Address - Fax:
Practice Address - Street 1:5 AUCOOT RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-2402
Practice Address - Country:US
Practice Address - Phone:508-758-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6389101YM0800X
MA4348411041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1309161Medicaid