Individual
SAMANTHA FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2602 LORRING DR, DISTRICT HEIGHTS, MD 20747-3310
(636) 295-9347
Mailing address
2602 LORRING DR, DISTRICT HEIGHTS, MD 20747-3310
(636) 295-9347
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-48633
MD
Other
Enumeration date
02/14/2019
Last updated
05/19/2021
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