Provider Demographics
NPI:1154685501
Name:PUENTE, YOLANDA (MSED)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310675
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-0675
Mailing Address - Country:US
Mailing Address - Phone:718-812-3182
Mailing Address - Fax:718-686-1868
Practice Address - Street 1:112 MINNA ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2116
Practice Address - Country:US
Practice Address - Phone:718-812-3182
Practice Address - Fax:718-686-1868
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-30
Last Update Date:2012-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency