Provider Demographics
NPI:1881133601
Name:FERNANDEZ, NICOLE ARLYN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ARLYN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ARLYN
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5126 W AGATITE AVE
Mailing Address - Street 2:# 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3702
Mailing Address - Country:US
Mailing Address - Phone:773-936-5844
Mailing Address - Fax:
Practice Address - Street 1:5126 W AGATITE AVE
Practice Address - Street 2:# 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3702
Practice Address - Country:US
Practice Address - Phone:773-936-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist