Provider Demographics
NPI:1467791731
Name:PUENTE, SIMON III (LCSW)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:PUENTE
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W ESCALON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2018
Mailing Address - Country:US
Mailing Address - Phone:559-312-4068
Mailing Address - Fax:
Practice Address - Street 1:5060 E CLINTON WAY
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1506
Practice Address - Country:US
Practice Address - Phone:559-253-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA747121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical