Provider Demographics
NPI:1588202592
Name:FERNANDEZ, ERICA (MSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-3402
Mailing Address - Country:US
Mailing Address - Phone:209-225-4481
Mailing Address - Fax:
Practice Address - Street 1:6313 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3402
Practice Address - Country:US
Practice Address - Phone:209-225-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1201631041C0700X
CAASW92255104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker