Provider Demographics
NPI:1699812321
Name:FERNANDEZ, VERONICA (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1617
Mailing Address - Country:US
Mailing Address - Phone:518-489-7777
Mailing Address - Fax:518-489-7771
Practice Address - Street 1:523 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1617
Practice Address - Country:US
Practice Address - Phone:518-489-7777
Practice Address - Fax:518-489-7771
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3601101YA0400X
NY0511401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA7015Medicare ID - Type Unspecified