Provider Demographics
NPI:1871023911
Name:PUENTE MEDINA, MARIA DEL CARMEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL CARMEN
Last Name:PUENTE MEDINA
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 1:100 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-3190
Mailing Address - Country:US
Mailing Address - Phone:757-736-3725
Mailing Address - Fax:757-431-7782
Practice Address - Street 1:100 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-3190
Practice Address - Country:US
Practice Address - Phone:757-736-3725
Practice Address - Fax:757-431-7782
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW-2911104100000X
HILCSW-52741041C0700X
VA09040187651041C0700X
AL6275C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker