Provider Demographics
NPI:1962252916
Name:FUENTES, EVARLENE (MSW)
Entity type:Individual
Prefix:MRS
First Name:EVARLENE
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:EVARLENE
Other - Middle Name:
Other - Last Name:FUENTES REYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:615 CALLE MONSERRATE
Mailing Address - Street 2:URB SANTA RITA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-909-6530
Mailing Address - Fax:
Practice Address - Street 1:615 CALLE MONSERRATE
Practice Address - Street 2:URB SANTA RITA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-909-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7552104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool