Provider Demographics
NPI:1568108090
Name:FERNANDEZ, EMILY RUTH
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:RUTH
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 FIRESTONE LN APT C
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5177
Mailing Address - Country:US
Mailing Address - Phone:219-477-8861
Mailing Address - Fax:
Practice Address - Street 1:2005 VALPARAISO ST STE 209
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3331
Practice Address - Country:US
Practice Address - Phone:219-252-5464
Practice Address - Fax:219-728-1860
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health