Provider Demographics
NPI:1942326210
Name:FERNANDES, MICHELLE TERESSA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:TERESSA
Last Name:FERNANDES
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 1:13809 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1906
Mailing Address - Country:US
Mailing Address - Phone:562-692-0383
Mailing Address - Fax:562-692-0380
Practice Address - Street 1:10155 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2063
Practice Address - Country:US
Practice Address - Phone:562-692-0383
Practice Address - Fax:562-692-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical