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General NPI Number Information
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NPI Number | 1487111779
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Entity Type | Organization
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Legal Business Name | PUENTE LLC
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Dates
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Enumeration Date | 02/23/2019
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 2611 VEGA CT
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City | RALEIGH
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State | NC
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Zip | 27614-6940
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Country | US
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Telephone | 919-399-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 VEGA CT
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City | RALEIGH
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State | NC
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Zip | 27614-6940
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Country | US
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Telephone | 919-399-9114
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. YEIMI AMPARO SANTANA
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Credential |
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Telephone | 919-399-9114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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