Provider Demographics
NPI:1225586894
Name:FERNANDEZ, LUCY AMELIA
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:AMELIA
Last Name:FERNANDEZ
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 1:11617 NW 62ND TER APT 426
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2893
Mailing Address - Country:US
Mailing Address - Phone:954-470-7317
Mailing Address - Fax:
Practice Address - Street 1:1350 SW 57TH AVE # 313
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5775
Practice Address - Country:US
Practice Address - Phone:305-262-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health