Healthcare Provider Details

I. General information

NPI: 1134942618
Provider Name (Legal Business Name): AMY LYNN MONTANEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LYNN FRIES

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SE CENTRAL PKWY STE 100
STUART FL
34994-5914
US

IV. Provider business mailing address

10 SE CENTRAL PKWY STE 100
STUART FL
34994-5914
US

V. Phone/Fax

Practice location:
  • Phone: 772-497-5985
  • Fax:
Mailing address:
  • Phone: 772-497-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: