Provider Demographics
NPI:1164601092
Name:PUENTE, BERNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNIE
Middle Name:
Last Name:PUENTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:BERNABE
Other - Middle Name:
Other - Last Name:PUENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4301 NW MOW WAY RD
Mailing Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL - MMD
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9018
Mailing Address - Country:US
Mailing Address - Phone:580-558-2972
Mailing Address - Fax:580-558-3515
Practice Address - Street 1:4301 NW MOW WAY RD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL - MMD
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-9018
Practice Address - Country:US
Practice Address - Phone:580-558-2972
Practice Address - Fax:580-558-3515
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical