Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
N | 104100000X | Social Worker | 30306 | TX |
N | 1041C0700X | Clinical Social Worker | 30306 | TX |
NPI | 1003844093 |
---|---|
Provider Name | Johnell Fernandez |
First Address | San Antonio, TX 78251-4326 |
Second Address | San Antonio, TX 78251-4326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 04/01/2022 |