Provider Demographics
NPI:1851668263
Name:FERNANDEZ, MARIELIS (BA)
Entity Type:Individual
Prefix:MS
First Name:MARIELIS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6822
Mailing Address - Country:US
Mailing Address - Phone:914-377-1855
Mailing Address - Fax:914-376-9859
Practice Address - Street 1:1 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6822
Practice Address - Country:US
Practice Address - Phone:914-377-1855
Practice Address - Fax:914-376-9859
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator