Provider Demographics
NPI:1033927827
Name:FERNANDES, MARY ASTRID (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ASTRID
Last Name:FERNANDES
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 1:12708 VALLEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4162
Mailing Address - Country:US
Mailing Address - Phone:240-688-1624
Mailing Address - Fax:
Practice Address - Street 1:12501 PROSPERITY DR STE 310
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1699
Practice Address - Country:US
Practice Address - Phone:240-780-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist