MEDICARE: CAROLINA FUENTES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	58169	TX

General Provider Information

NPI Number	:	1629785464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA FUENTES LCSW

Provider Business Mailing Address
First Line	:	19627 INTERSTATE 45 N STE 210
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6028
Country	:	US
Telephone Number	:	281-857-4537
Fax Number	:

Provider Business Practice Location Address
First Line	:	19627 INTERSTATE 45 N STE 210
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6028
Country	:	US
Telephone Number	:	281-857-4537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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Directions to “ CAROLINA FUENTES LCSW” Practice Location

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