Provider Demographics
NPI:1790413516
Name:FERNANDEZ, CARLA A (LMHC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:A
Other - Last Name:RENNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 348741
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33234-8741
Mailing Address - Country:US
Mailing Address - Phone:352-275-6168
Mailing Address - Fax:305-356-8055
Practice Address - Street 1:999 PONCE DE LEON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3077
Practice Address - Country:US
Practice Address - Phone:352-275-6168
Practice Address - Fax:305-356-8055
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21120101YM0800X
NY009244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health