Healthcare Provider Details

I. General information

NPI: 1023582335
Provider Name (Legal Business Name): EMELINDA ROSA MONTANEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 DIXWELL AVE STE 300B
HAMDEN CT
06518-3159
US

IV. Provider business mailing address

2911 DIXWELL AVE STE 300B
HAMDEN CT
06518-3159
US

V. Phone/Fax

Practice location:
  • Phone: 860-704-9483
  • Fax:
Mailing address:
  • Phone: 860-704-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number232
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: