Provider Demographics
NPI:1194970608
Name:FUENTES, ALAN (LCSW-R)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LIBERTY SQUARE
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980
Mailing Address - Country:US
Mailing Address - Phone:845-429-6900
Mailing Address - Fax:845-429-7050
Practice Address - Street 1:27 LIBERTY SQUARE
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980
Practice Address - Country:US
Practice Address - Phone:845-429-6900
Practice Address - Fax:845-429-7050
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0541031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02180803Medicaid