Provider Demographics
NPI:1508269507
Name:FERNANDEZ, ERNEST RONALD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:RONALD
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SOUTH BLVD
Mailing Address - Street 2:APT. 3S
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2719
Mailing Address - Country:US
Mailing Address - Phone:773-614-3099
Mailing Address - Fax:
Practice Address - Street 1:1845 GRANDSTAND PL
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4983
Practice Address - Country:US
Practice Address - Phone:847-695-0484
Practice Address - Fax:847-695-1265
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490166231041C0700X
IL18325211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool