Provider Demographics
NPI:1023314614
Name:FERNANDEZ, JONATHAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 CALLE MARGINAL VILLAMAR
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6345
Mailing Address - Country:US
Mailing Address - Phone:787-539-0404
Mailing Address - Fax:787-945-7128
Practice Address - Street 1:1207 CALLE MARGINAL VILLAMAR
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6345
Practice Address - Country:US
Practice Address - Phone:787-539-0404
Practice Address - Fax:787-945-7128
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3872OtherPSYCHOLOGY PUERTO RICO LICENCE