Provider Demographics
NPI:1053155226
Name:FUENTES, WANDA ESTHER (LCSW)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:ESTHER
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3483
Mailing Address - Country:US
Mailing Address - Phone:904-701-8093
Mailing Address - Fax:
Practice Address - Street 1:317 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3483
Practice Address - Country:US
Practice Address - Phone:904-701-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW210741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical