Provider Demographics
NPI:1760804249
Name:FERNANDEZ, CARMEN L (MASTER)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER
Mailing Address - Street 1:EXTENCION MARISOL CALLE 3
Mailing Address - Street 2:BUZON 106
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2957
Mailing Address - Country:US
Mailing Address - Phone:787-585-9646
Mailing Address - Fax:
Practice Address - Street 1:EXTENCION MARISOL CALLE 3
Practice Address - Street 2:BUZON 106
Practice Address - City:ARECIBO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00612
Practice Address - Country:UM
Practice Address - Phone:787-585-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical