Provider Demographics
NPI:1730414350
Name:FERNANDES, ERIN M
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:PITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 AIRPORT ROA
Mailing Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ, INC.
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-367-4700
Mailing Address - Fax:732-364-2253
Practice Address - Street 1:700 AIRPORT ROA
Practice Address - Street 2:PREFERRED BEHAVIORAL HEALTH OF NJ, INC.
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-4700
Practice Address - Fax:732-364-2253
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05575300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid
NJ526788OtherGROUP MEDICARE NUMBER