Provider Demographics
NPI:1568743284
Name:FERNANDEZ, ELIZABETH ANDREA (CD (DONA), LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANDREA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CD (DONA), LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:275 FAIR ST
Mailing Address - Street 2:STE 28
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3882
Mailing Address - Country:US
Mailing Address - Phone:845-706-9385
Mailing Address - Fax:845-338-2540
Practice Address - Street 1:275 FAIR ST
Practice Address - Street 2:STE 28
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3882
Practice Address - Country:US
Practice Address - Phone:845-706-9385
Practice Address - Fax:845-338-2540
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3965374J00000X
NY081408-1104100000X
NY08-09111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula
No104100000XBehavioral Health & Social Service ProvidersSocial Worker