Healthcare Provider Details

I. General information

NPI: 1366361016
Provider Name (Legal Business Name): NICOLE DE LA FUENTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 JENA ST STE 103
NEW ORLEANS LA
70115-6322
US

IV. Provider business mailing address

1466 CRESCENT DR
NEW ORLEANS LA
70122-2008
US

V. Phone/Fax

Practice location:
  • Phone: 504-434-2114
  • Fax:
Mailing address:
  • Phone: 504-434-2114
  • Fax: 504-434-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DE LA FUENTE
Title or Position: FOUNDER/CEO
Credential: LCSW-BACS
Phone: 504-434-2114