Healthcare Provider Details

I. General information

NPI: 1841263563
Provider Name (Legal Business Name): CHERYL LYNN MONTALBANO-RAHMANY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 INDIANA AVE
VALPARAISO IN
46383-5542
US

IV. Provider business mailing address

2158 45TH ST # 202
HIGHLAND IN
46322-3742
US

V. Phone/Fax

Practice location:
  • Phone: 219-386-1092
  • Fax: 219-476-7558
Mailing address:
  • Phone: 219-386-1092
  • Fax: 219-476-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000794A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001744A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: