Provider Demographics
NPI:1447567300
Name:FERNANDES, NICOLE E
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:E
Last Name:FERNANDES
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 1:700 ASHFORD AVENUE
Mailing Address - Street 2:ARDSLEY MIDDLE SCHOOL
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-693-7564
Mailing Address - Fax:914-674-1929
Practice Address - Street 1:700 ASHFORD AVENUE
Practice Address - Street 2:ARDSLEY MIDDLE SCHOOL
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-693-7564
Practice Address - Fax:914-674-1929
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool