MEDICARE: MARIA DEL CARMEN PUENTE MEDINA 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	104100000X	Social Worker	LSW-2911	HI
2	1041C0700X	Clinical Social Worker	LCSW-5274	HI
3	1041C0700X	Clinical Social Worker	0904018765	VA
4	1041C0700X	Clinical Social Worker	6275C	AL

General Provider Information

NPI Number	:	1871023911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DEL CARMEN PUENTE MEDINA LCSW

Provider Business Mailing Address
First Line	:	100 ENTERPRISE DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-3190
Country	:	US
Telephone Number	:	757-736-3725
Fax Number	:	757-431-7782

Provider Business Practice Location Address
First Line	:	100 ENTERPRISE DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-3190
Country	:	US
Telephone Number	:	757-736-3725
Fax Number	:	757-431-7782

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	11/05/2025

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