Provider Demographics
NPI:1033304456
Name:FUENTES, LORI ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-548-8727
Mailing Address - Fax:219-465-7211
Practice Address - Street 1:607 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-548-8727
Practice Address - Fax:219-465-7211
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200275200AMedicaid
IN200880Medicare UPIN