Provider Demographics
NPI:1922370576
Name:FERNANDEZ, BONNIE ROSE (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:ROSE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4742
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921-4742
Mailing Address - Country:US
Mailing Address - Phone:821-214-2792
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN 2NW OF 7TH
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93921-4742
Practice Address - Country:US
Practice Address - Phone:821-214-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist