Healthcare Provider Details

I. General information

NPI: 1982423083
Provider Name (Legal Business Name): VANESSA MONTOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 ELM ST
WORCESTER MA
01609-2541
US

IV. Provider business mailing address

3 COMMONWEALTH AVE # 17
ATTLEBORO MA
02703-1064
US

V. Phone/Fax

Practice location:
  • Phone: 774-391-8840
  • Fax:
Mailing address:
  • Phone: 774-219-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: