Provider Demographics
NPI:1558486563
Name:FERNANDEZ, JENNIFER (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-1013
Mailing Address - Country:US
Mailing Address - Phone:267-977-6876
Mailing Address - Fax:
Practice Address - Street 1:1808 COLONIAL VILLAGE LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6745
Practice Address - Country:US
Practice Address - Phone:717-391-6808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical