Doctor Name: | MS. MICHELLE LEE FERNANDES |
NPI Number: | 1043416092 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ME.D. IN MHC |
License Number: | 101YM0800X |
Business Practice Address: | 95 Pleasant St Lynn, MA - 019011524 |
Business Phone Number: | 7815969222 |
Business Fax Number: | 7815819876 |
Mailing Address: | 95 Pleasant St, LYNN |
State: | MA |
Postal Code: | 019011524 |
Phone Number: | 7815969222 |
Fax Number: | 7815819876 |
NPI Enumeration Date: | 06/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 101YM0800X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |