Provider Demographics
NPI:1235480484
Name:FERMIN, YESENIA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:
Last Name:FERMIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:YESENIA
Other - Middle Name:R
Other - Last Name:BEUTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:P.O. BOX 2562
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07091
Mailing Address - Country:US
Mailing Address - Phone:908-652-7061
Mailing Address - Fax:
Practice Address - Street 1:525 BOULEVARD SUITE 2
Practice Address - Street 2:SUITE 2
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033
Practice Address - Country:US
Practice Address - Phone:908-652-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055175001041C0700X
NJNJ44SC05S175001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical