Individual
LISSETH FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
87 E SPRING VALLEY AVE, MAYWOOD, NJ 07607-2122
(917) 724-7695
Mailing address
87 E SPRING VALLEY AVE, MAYWOOD, NJ 07607-2122
(917) 724-7695
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0294041
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0294041
0294041
—
Enumeration date
11/04/2020
Last updated
11/04/2020
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