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General NPI Number Information
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NPI Number | 1871023911
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Entity Type | Individual
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Provider Name | MARIA DEL CARMEN PUENTE MEDINA LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 100 ENTERPRISE DR
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City | YORKTOWN
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State | VA
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Zip | 23692-3190
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Country | US
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Telephone | 757-736-3725
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Fax | 757-431-7782
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Provider Business Mailing Address
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Address Line | 100 ENTERPRISE DR
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City | YORKTOWN
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State | VA
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Zip | 23692-3190
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Country | US
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Telephone | 757-736-3725
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Fax | 757-431-7782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-2911
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-5274
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904018765
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6275C
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License Number State | AL
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