Healthcare Provider Details

I. General information

NPI: 1992599344
Provider Name (Legal Business Name): AMANDA MARIE FUERTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 EASTLAKE PKWY STE 102 #1158
CHULA VISTA CA
91915
US

IV. Provider business mailing address

1741 EASTLAKE PKWY STE 102 #1158
CHULA VISTA CA
91915
US

V. Phone/Fax

Practice location:
  • Phone: 619-324-0186
  • Fax:
Mailing address:
  • Phone: 619-324-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: