Provider Demographics
NPI:1558384628
Name:FERNANDEZ, ALBERT C (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:C
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 N FLAMINGO RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3501
Mailing Address - Country:US
Mailing Address - Phone:305-778-6381
Mailing Address - Fax:954-885-0638
Practice Address - Street 1:2114 N FLAMINGO RD STE 205
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3501
Practice Address - Country:US
Practice Address - Phone:305-778-6381
Practice Address - Fax:954-885-0638
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6609Medicare PIN