Provider Demographics
NPI:1861019820
Name:FERNANDEZ, NANCY VILLALOBOS (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:VILLALOBOS
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6757
Mailing Address - Country:US
Mailing Address - Phone:916-813-4342
Mailing Address - Fax:
Practice Address - Street 1:179 PROVIDENCE PL
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6757
Practice Address - Country:US
Practice Address - Phone:916-813-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical