Provider Demographics
NPI:1871810499
Name:FERNANDEZ, CHERYL DIANE (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17782 MORO RD
Mailing Address - Street 2:
Mailing Address - City:PRUNEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93907-8961
Mailing Address - Country:US
Mailing Address - Phone:831-594-3115
Mailing Address - Fax:
Practice Address - Street 1:17840 MORO RD
Practice Address - Street 2:
Practice Address - City:PRUNEDALE
Practice Address - State:CA
Practice Address - Zip Code:93907-8564
Practice Address - Country:US
Practice Address - Phone:831-594-3115
Practice Address - Fax:831-443-3753
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37200106H00000X
CA106H00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist