Healthcare Provider Details

I. General information

NPI: 1700495405
Provider Name (Legal Business Name): ANTONIA PATRICE MONTOYA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 4TH ST NW UNIT B
LOS RANCHOS NM
87114-1407
US

IV. Provider business mailing address

PO BOX 27191
ALBUQUERQUE NM
87125-7191
US

V. Phone/Fax

Practice location:
  • Phone: 505-333-9336
  • Fax:
Mailing address:
  • Phone: 505-333-9336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0144
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: