Provider Demographics
NPI:1861013310
Name:FERNANDEZ, ISIS M (CBHCM)
Entity Type:Individual
Prefix:MRS
First Name:ISIS
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5273 NW 2ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5027
Mailing Address - Country:US
Mailing Address - Phone:786-250-7892
Mailing Address - Fax:
Practice Address - Street 1:5273 NW 2ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5027
Practice Address - Country:US
Practice Address - Phone:786-250-7892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-335841106S00000X
FLCBHCM102437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician