Active NPI
Raquel Fernandes
- Mental Health Counselor
- Coram, NY
National Provider Identifier
1003571878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 3600 Route 112
Coram, NY 11727-4116 - Phone
- (631) 920-8500
- NPI assigned
- Nov 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
3600 Route 112
Coram, NY 11727-4116
Mailing address
3600 Route 112
Coram, NY 11727-4116
Phone (631) 920-8500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 11, 2024 through Nov 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015569 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636761600000",
"number": "1003571878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 ROUTE 112",
"city": "CORAM",
"state": "NY",
"postal_code": "117274116",
"telephone_number": "631-920-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDES",
"first_name": "RAQUEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-05",
"last_updated": "2021-11-13",
"certification_date": "2021-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.