Provider Demographics
NPI:1457697740
Name:FERNANDEZ, MARTA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16318 JAMAICA AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4919
Mailing Address - Country:US
Mailing Address - Phone:718-658-0010
Mailing Address - Fax:718-658-2909
Practice Address - Street 1:16318 JAMAICA AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4919
Practice Address - Country:US
Practice Address - Phone:718-658-0010
Practice Address - Fax:718-658-2909
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 088126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker