Manuel Enrique Fernandez, PSYD, MSCP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY26787 Issued in CA

Practice address

1070 Concord Ave Ste 109
Concord, CA 94520-5608

Phone

(925) 849-5349

Fax

(925) 270-3382

NPI assigned

Oct 2, 2007

Last updated

Aug 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• La Concordia Psychotherapy and Wellness Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Concord, CA
  • NPI 1154933026
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597968000000",
    "number": "1558558676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 CONCORD AVE STE 109",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205608",
            "telephone_number": "925-849-5349",
            "fax_number": "925-270-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 CONCORD AVE STE 109",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945205608",
            "telephone_number": "925-849-5349",
            "fax_number": "925-270-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "MANUEL",
        "middle_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "PSYD, MSCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-02",
        "last_updated": "2020-08-21",
        "certification_date": "2020-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "PSY 26787",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "PSY 26787",
            "primary": false
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY26787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1750641189",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Fernandez Quintero
• Abigail Fernandez
• Alejandra Fernandez
• Ariana Fernandez
• Kassandra Louise Fernandez
• Ronald Fernandez
• Priscilla Ferreira Servin
• Bryan Ferreira
• Reagan Ferreira
• Joseph Ferrell

• Clinical Psychologist in Concord, CA
• Providers in Concord, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.