Provider Demographics
NPI:1760246714
Name:FERNANDEZ, ESTHER MEJIA (LSW)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:MEJIA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1513
Mailing Address - Country:US
Mailing Address - Phone:508-739-3185
Mailing Address - Fax:
Practice Address - Street 1:112 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1148
Practice Address - Country:US
Practice Address - Phone:781-595-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA315122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker