Provider Demographics
NPI:1518148543
Name:FERNANDEZ, RICHARD ELIAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ELIAS
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EAST FLAGLER ST
Mailing Address - Street 2:SUITE 432
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131
Mailing Address - Country:US
Mailing Address - Phone:305-397-9094
Mailing Address - Fax:786-220-7397
Practice Address - Street 1:223 EAST FLAGLER ST
Practice Address - Street 2:SUITE 432
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131
Practice Address - Country:US
Practice Address - Phone:305-397-9094
Practice Address - Fax:786-220-7397
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL PY 7672103G00000X, 103TC0700X
FLPY 7672103TM1800X, 103T00000X, 103TA0400X, 103TA0700X, 103TC2200X, 103TF0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling