Provider Demographics
NPI:1316495815
Name:FERNANDEZ, GRIMARIE (MS, LMHC, MCAP)
Entity type:Individual
Prefix:
First Name:GRIMARIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS, LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N THACKER AVE STE D31
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4808
Mailing Address - Country:US
Mailing Address - Phone:321-732-2315
Mailing Address - Fax:321-222-6228
Practice Address - Street 1:600 N THACKER AVE STE D31
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4808
Practice Address - Country:US
Practice Address - Phone:321-732-2315
Practice Address - Fax:321-222-6228
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20482101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty