Healthcare Provider Details

I. General information

NPI: 1003729005
Provider Name (Legal Business Name): MARIANA FUENTES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BROAD ST
NEW YORK NY
10004-2400
US

IV. Provider business mailing address

523 FRANKLIN AVE
BROOKLYN NY
11238-6791
US

V. Phone/Fax

Practice location:
  • Phone: 956-605-0482
  • Fax:
Mailing address:
  • Phone: 956-605-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130061-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: