Healthcare Provider Details

I. General information

NPI: 1043561186
Provider Name (Legal Business Name): SUSANA MONTANEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 S EASTERN AVE
COMMERCE CA
90040-4029
US

IV. Provider business mailing address

PO BOX 1183
WHITTIER CA
90609-1183
US

V. Phone/Fax

Practice location:
  • Phone: 323-243-4629
  • Fax:
Mailing address:
  • Phone: 323-243-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 28521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: