Provider Demographics
NPI:1982331732
Name:FUENTES, ALLYSON (LPAT, LCAT)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LPAT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1425
Mailing Address - Country:US
Mailing Address - Phone:914-850-6955
Mailing Address - Fax:
Practice Address - Street 1:9 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1425
Practice Address - Country:US
Practice Address - Phone:914-850-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00001800221700000X
NY002742221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty