Provider Demographics
NPI:1679631998
Name:FERNANDEZ, SHANNA LYN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:LYN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LYN
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1229
Mailing Address - Country:US
Mailing Address - Phone:585-922-2500
Mailing Address - Fax:585-922-2664
Practice Address - Street 1:490 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1229
Practice Address - Country:US
Practice Address - Phone:585-922-2500
Practice Address - Fax:585-922-2664
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068610104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker