Provider Demographics
NPI:1821104837
Name:FUENTES, DELIA E (LCSW)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:E
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 LEE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2104
Mailing Address - Country:US
Mailing Address - Phone:407-301-3460
Mailing Address - Fax:904-592-6621
Practice Address - Street 1:1850 LEE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2104
Practice Address - Country:US
Practice Address - Phone:407-301-3460
Practice Address - Fax:904-592-6621
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 70781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW7078OtherLICENSED CLINICAL SOCIAL WORKER
1821104837Medicare UPIN
FLSW7078OtherLICENSED CLINICAL SOCIAL WORKER