Individual
MARY JO FRANCES FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1135 NW 23RD AVE, SUITE G, GAINESVILLE, FL 32609-5415
(781) 710-6539
Mailing address
11307 NW 60TH TER, ALACHUA, FL 32615-7415
(781) 710-6539
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
7249
MA
103TC1900X
Counseling Psychologist
Primary
PY 9485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0501417
—
MA
01
—
401761
TUFTS
—
01
—
W05960
BCBS
MA
Enumeration date
07/03/2006
Last updated
07/21/2016
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