Provider Demographics
NPI:1205496320
Name:FUENTES, MARY-ELIZABETH ELEANOR (LPC LCADC, NCC)
Entity type:Individual
Prefix:MS
First Name:MARY-ELIZABETH
Middle Name:ELEANOR
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LPC LCADC, NCC
Other - Prefix:MS
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCADC, NCC
Mailing Address - Street 1:44 PILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2802
Mailing Address - Country:US
Mailing Address - Phone:609-941-7486
Mailing Address - Fax:
Practice Address - Street 1:20 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY CORNER
Practice Address - State:NJ
Practice Address - Zip Code:07938
Practice Address - Country:US
Practice Address - Phone:973-348-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00769500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health