Provider Demographics
NPI:1316546260
Name:FERNANDEZ, KLEAH (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:KLEAH
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:KLEAH DANIELLE
Other - Middle Name:MABALHIN
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LCSW
Mailing Address - Street 1:5240 N SHERIDAN RD APT 1203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7301
Mailing Address - Country:US
Mailing Address - Phone:773-541-0403
Mailing Address - Fax:
Practice Address - Street 1:5080 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2459
Practice Address - Country:US
Practice Address - Phone:773-541-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0260051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical