Basic Information
| Provider Information | |||||||||
| NPI: | 1508269507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 SOUTH BLVD | ||||||||
| Address2: | APT. 3S | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603022719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736143099 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1845 GRANDSTAND PL | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476950484 | ||||||||
| FaxNumber: | 8476951265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149016623 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041S0200X | 1832521 | IL | N | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.