Provider Demographics
NPI:1366801722
Name:DE LA FUENTE, AURELIO JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:AURELIO
Middle Name:
Last Name:DE LA FUENTE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 BAHAMAS DR
Mailing Address - Street 2:NUMBER 2
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541
Mailing Address - Country:US
Mailing Address - Phone:956-414-3996
Mailing Address - Fax:
Practice Address - Street 1:400 N ALLEN DR STE 204
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2568
Practice Address - Country:US
Practice Address - Phone:972-233-1010
Practice Address - Fax:214-623-6692
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61487104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker