MEDICARE: MS. SUSANA Q. MONTALVO M.A.,M.S.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMHC2997	FL

General Provider Information

NPI Number	:	1033275607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANA Q. MONTALVO M.A.,M.S.ED.

Provider Business Mailing Address
First Line	:	8537 BUCKLEY CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-1664
Country	:	US
Telephone Number	:	407-310-1273
Fax Number	:	407-677-6829

Provider Business Practice Location Address
First Line	:	934 N MAGNOLIA AVE
Second Line	:	STE.119
City	:	ORLANDO
State	:	FL
Zip	:	32803-3840
Country	:	US
Telephone Number	:	407-310-1273
Fax Number	:	407-677-6829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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