Provider Demographics
NPI:1902422892
Name:FERNANDEZ, JUDITH (RBT, BCBA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RBT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2977 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6012
Mailing Address - Country:US
Mailing Address - Phone:239-895-5014
Mailing Address - Fax:
Practice Address - Street 1:2977 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6012
Practice Address - Country:US
Practice Address - Phone:239-895-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119889106S00000X
FL1-21-56397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician