Provider Demographics
NPI:1477986339
Name:DE LA FUENTE, MARIA IRMA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:IRMA
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 STILLHOUSE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:214-704-4202
Mailing Address - Fax:
Practice Address - Street 1:1821 STILLHOUSE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8499
Practice Address - Country:US
Practice Address - Phone:214-704-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18286171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator