Provider Demographics
NPI:1922787605
Name:FERNANDEZ GONZALEZ, ALBERTO (MS)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:FERNANDEZ GONZALEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SULLIVAN PL APT B3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2701
Mailing Address - Country:US
Mailing Address - Phone:720-295-1308
Mailing Address - Fax:
Practice Address - Street 1:720 S COLORADO BLVD PH NORTH
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:720-295-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2025-04-14
Deactivation Date:2023-11-09
Deactivation Code:
Reactivation Date:2024-07-19
Provider Licenses
StateLicense IDTaxonomies
CO0020406101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty