Provider Demographics
NPI:1548483415
Name:FERNANDEZ, KATHLEEN A (CAS)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:PEPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAS
Mailing Address - Street 1:10164 SWANTON DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1063
Mailing Address - Country:US
Mailing Address - Phone:619-729-5454
Mailing Address - Fax:
Practice Address - Street 1:7841 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3709
Practice Address - Country:US
Practice Address - Phone:619-697-2388
Practice Address - Fax:619-697-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-056936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health