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Organization
SAFE SPACE LICENSED CLINICAL SOCIAL WORK, P.C.
Active
Organization
SAFE SPACE LICENSED CLINICAL SOCIAL WORK, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE FUENTES LCSW (OWNER)
(863) 738-7808
Entity
Organization
Contact information
Practice address
3249 KINGSBRIDGE AVE, BRONX, NY 10463-5514
(917) 969-2445
Mailing address
8810 FOX DR, POLK CITY, FL 33868-6024
(863) 738-7808
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06578821
—
NY
Enumeration date
12/14/2021
Last updated
08/11/2023
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