Healthcare Provider Details

I. General information

NPI: 1962535351
Provider Name (Legal Business Name): RICHARD A MONTANTES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

IV. Provider business mailing address

755 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4517
  • Fax: 415-695-6961
Mailing address:
  • Phone: 415-642-4517
  • Fax: 415-695-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS20086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: