Provider Demographics
NPI:1144931411
Name:FERNANDES, JESSICA (MSW, RCSWI)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5275 EUROPA DR APT E
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2147
Mailing Address - Country:US
Mailing Address - Phone:908-499-7621
Mailing Address - Fax:
Practice Address - Street 1:8198 S JOG RD STE 201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-6903
Practice Address - Country:US
Practice Address - Phone:561-810-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker