Provider Demographics
NPI:1053048561
Name:FERNANDEZ MENDEZ, NATHALIE ALEJANDRA
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:ALEJANDRA
Last Name:FERNANDEZ MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W GILBREATH ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-2913
Mailing Address - Country:US
Mailing Address - Phone:631-953-5005
Mailing Address - Fax:
Practice Address - Street 1:310 W GILBREATH ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2913
Practice Address - Country:US
Practice Address - Phone:631-953-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health