Provider Demographics
NPI:1821293234
Name:FERNANDES, SARA MARIA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIA
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHARLESGATE W
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2703
Mailing Address - Country:US
Mailing Address - Phone:617-803-5619
Mailing Address - Fax:
Practice Address - Street 1:20 CHARLESGATE W
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2703
Practice Address - Country:US
Practice Address - Phone:617-803-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool