Provider Demographics
NPI:1477272391
Name:FERNANDEZ, MEGAN (LCSW-CC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LCSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7344
Mailing Address - Country:US
Mailing Address - Phone:207-423-4095
Mailing Address - Fax:
Practice Address - Street 1:7 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7344
Practice Address - Country:US
Practice Address - Phone:207-423-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC191211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical