Individual
TROY DEAN FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1210 LUISA ST, #6, SANTA FE, NM 87505-4175
(505) 310-2183
Mailing address
1420 GALISTEO ST, SANTA FE, NM 87505-4632
(505) 310-2183
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I-04850
NM
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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