Provider Demographics
NPI:1770812711
Name:FERNANDEZ, VANESSA CHRISTINE (BCABA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:CHRISTINE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 NW 107TH CT
Mailing Address - Street 2:UNIT 101
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2143
Mailing Address - Country:US
Mailing Address - Phone:786-838-3179
Mailing Address - Fax:
Practice Address - Street 1:8933 NW 107TH CT
Practice Address - Street 2:UNIT 101
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2143
Practice Address - Country:US
Practice Address - Phone:786-838-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-10-3958103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst