| Doctor Name: | JEIDY MERCEDES FERNANDEZ |
| NPI Number: | 1023379799 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | |
| Business Practice Address: | 112 Central St Waltham, MA - 024535465 |
| Business Phone Number: | 7818910556 |
| Business Fax Number: | |
| Mailing Address: | 350 Engamore Ln Apt 101, NORWOOD |
| State: | MA |
| Postal Code: | 020622589 |
| Phone Number: | 6177751357 |
| Fax Number: | |
| NPI Enumeration Date: | 05/30/2012 |
| NPI Last Update Date: | 01/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |