Provider Demographics
NPI:1346912730
Name:FERNANDEZ HERNANDEZ, CECILIA (BCBA)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:FERNANDEZ HERNANDEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 1ST AVE APT 516
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4938
Mailing Address - Country:US
Mailing Address - Phone:786-600-8018
Mailing Address - Fax:
Practice Address - Street 1:150 E 1ST AVE APT 516
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4938
Practice Address - Country:US
Practice Address - Phone:786-600-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA-1-21-49856103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst