Provider Demographics
NPI:1982055117
Name:FERNANDEZ PEREZ, LOURDES (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:FERNANDEZ PEREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12800 SW 43RD DR APT 208B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4149
Mailing Address - Country:US
Mailing Address - Phone:786-447-5070
Mailing Address - Fax:
Practice Address - Street 1:12800 SW 43RD DR APT 208B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4149
Practice Address - Country:US
Practice Address - Phone:786-447-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-18-8713103K00000X
106S00000X
1-20-45005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician