Provider Demographics
NPI:1538705264
Name:FERNANDEZ, KAROLYNA (MA, LAC)
Entity Type:Individual
Prefix:MS
First Name:KAROLYNA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOREST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5245
Mailing Address - Country:US
Mailing Address - Phone:201-880-7530
Mailing Address - Fax:201-880-7529
Practice Address - Street 1:6 FOREST AVE STE 1
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5245
Practice Address - Country:US
Practice Address - Phone:201-880-7530
Practice Address - Fax:201-880-7529
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00451800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)