Provider Demographics
NPI:1982059218
Name:FERNANDEZ, ANA (PHD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CONWELL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1278
Mailing Address - Country:US
Mailing Address - Phone:917-628-0741
Mailing Address - Fax:
Practice Address - Street 1:58 CONWELL AVE #1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1278
Practice Address - Country:US
Practice Address - Phone:917-628-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10539-PY-PR103T00000X
FLPY 8913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist