Provider Demographics
NPI:1952638124
Name:FERNANDEZ, BEVERLY M (BA)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-1218
Mailing Address - Country:US
Mailing Address - Phone:305-759-8888
Mailing Address - Fax:305-757-5989
Practice Address - Street 1:11031 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7182
Practice Address - Country:US
Practice Address - Phone:305-398-6100
Practice Address - Fax:305-757-4465
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor