Provider Demographics
NPI:1285142836
Name:FERNANDO, LEONIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEONIE
Middle Name:
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5728
Mailing Address - Country:US
Mailing Address - Phone:281-889-0161
Mailing Address - Fax:
Practice Address - Street 1:46 E SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-5728
Practice Address - Country:US
Practice Address - Phone:281-889-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical