Provider Demographics
NPI:1801407598
Name:FERNANDEZ, ERIKA RAQUEL (RBT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:RAQUEL
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:RAQUEL
Other - Last Name:FERNANDEZ-UGARTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:13121 ATLANTIC BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0102
Mailing Address - Country:US
Mailing Address - Phone:904-491-2111
Mailing Address - Fax:904-512-0613
Practice Address - Street 1:13121 ATLANTIC BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-0102
Practice Address - Country:US
Practice Address - Phone:904-491-2111
Practice Address - Fax:904-512-0613
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-20-129930OtherBEHAVIORAL ANALYST CERTIFICATION BOARD