Healthcare Provider Details

I. General information

NPI: 1629146139
Provider Name (Legal Business Name): ALLISON KATHLEEN PUENTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 COVERT AVE
FLORAL PARK NY
11001-3219
US

IV. Provider business mailing address

87 COVERT AVE
FLORAL PARK NY
11001-3219
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-0077
  • Fax:
Mailing address:
  • Phone: 917-670-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: