Provider Demographics
NPI:1851427223
Name:FERNANDEZ, VICTORIA ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:MORESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:44658 BAYVIEW AVE
Mailing Address - Street 2:#10105
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7024
Mailing Address - Country:US
Mailing Address - Phone:586-907-0069
Mailing Address - Fax:586-948-0213
Practice Address - Street 1:44658 BAYVIEW AVE
Practice Address - Street 2:#10105
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7024
Practice Address - Country:US
Practice Address - Phone:586-907-0069
Practice Address - Fax:586-948-0213
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071796251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical