Provider Demographics
NPI:1427265875
Name:FUENTES, STEPHANIE J
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N CORPORATE LAKES BLVD UNIT 268672
Mailing Address - Street 2:HOLDING HANDS AUTISM, LLC
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-9999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1870 N CORPORATE LAKES BLVD UNIT 268672
Practice Address - Street 2:HOLDING HANDS AUTISM, LLC
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-9999
Practice Address - Country:US
Practice Address - Phone:305-510-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH 10778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health