Provider Demographics
NPI:1447966692
Name:FUENTES, IRMARY (MRC, CRC)
Entity type:Individual
Prefix:
First Name:IRMARY
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MRC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E CUMBERLAND AVE UNIT 136
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4237
Mailing Address - Country:US
Mailing Address - Phone:813-399-3131
Mailing Address - Fax:
Practice Address - Street 1:2103 N ROME AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3509
Practice Address - Country:US
Practice Address - Phone:813-825-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor