| Doctor Name: | MS. MARY ROSE FERNANDEZ |
| NPI Number: | 1265678965 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 004349-1 |
| Business Practice Address: | 9502 Rockaway Beach Blvd Rockaway Beach, NY - 116931317 |
| Business Phone Number: | 7184742478 |
| Business Fax Number: | |
| Mailing Address: | 327 Beach 19 Street, FAR ROCKAWAY |
| State: | NY |
| Postal Code: | 11691 |
| Phone Number: | 7184742478 |
| Fax Number: | |
| NPI Enumeration Date: | 12/30/2008 |
| NPI Last Update Date: | 01/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 004349-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |