Provider Demographics
NPI:1780832832
Name:FERNANDEZ, BECKY AMARILIS (LMSW, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:AMARILIS
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W 52ND ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5083
Mailing Address - Country:US
Mailing Address - Phone:646-626-2186
Mailing Address - Fax:
Practice Address - Street 1:501 W 52ND ST
Practice Address - Street 2:APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5083
Practice Address - Country:US
Practice Address - Phone:646-626-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21148101YA0400X
NY090077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)