Provider Demographics
NPI:1578040945
Name:FERNANDEZ, MARC (LMFT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ATLANTIC AVE UNIT 605
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-7028
Mailing Address - Country:US
Mailing Address - Phone:347-915-3907
Mailing Address - Fax:
Practice Address - Street 1:3074 XAVIER PL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4223
Practice Address - Country:US
Practice Address - Phone:347-915-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist