Basic Information
| Provider Information | |||||||||
| NPI: | 1033484522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | MACARENA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA CCC-SLP/BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 AZALEA DR | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208502015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017855334 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7175 COLUMBIA GATEWAY DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210462534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883445977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2012 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 06572 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 103K00000X | 039 | MD | N | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.