Provider Demographics
NPI:1427464049
Name:FERNANDEZ, JACQUELINE ANN (MA, LPC, LCADC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-0267
Mailing Address - Country:US
Mailing Address - Phone:908-303-3850
Mailing Address - Fax:
Practice Address - Street 1:1001 COUNTY ROAD 517
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2730
Practice Address - Country:US
Practice Address - Phone:908-303-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00179200101YA0400X
NJ37PC00496100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)