Provider Demographics
NPI:1073957791
Name:FUENTES, ANGELICA C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:C
Last Name:FUENTES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E PARK ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1973
Mailing Address - Country:US
Mailing Address - Phone:630-730-0864
Mailing Address - Fax:630-654-1195
Practice Address - Street 1:201 E PARK ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1973
Practice Address - Country:US
Practice Address - Phone:630-730-0864
Practice Address - Fax:630-654-1195
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007521103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist