Provider Demographics
NPI:1922609056
Name:FERNANDEZ RODRIGUEZ, NAOMI (MSW)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:FERNANDEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 CEDAR LAKE RD S STE 202
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1479
Mailing Address - Country:US
Mailing Address - Phone:763-250-9025
Mailing Address - Fax:952-674-6270
Practice Address - Street 1:5871 CEDAR LAKE RD S STE 202
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1479
Practice Address - Country:US
Practice Address - Phone:763-250-9025
Practice Address - Fax:952-674-6270
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical