Healthcare Provider Details

I. General information

NPI: 1962867549
Provider Name (Legal Business Name): NINETTE MONTERO BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N LECANTO HWY STE 532
LECANTO FL
34461-8547
US

IV. Provider business mailing address

508 N LECANTO HWY STE 532
LECANTO FL
34461-8547
US

V. Phone/Fax

Practice location:
  • Phone: 352-228-4969
  • Fax: 352-228-8901
Mailing address:
  • Phone: 630-221-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: