Healthcare Provider Details

I. General information

NPI: 1154984813
Provider Name (Legal Business Name): GRACE KELLY MONTECER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE KELLY MAIER

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BENCHLEY PL FRNT 2
BRONX NY
10475-3402
US

IV. Provider business mailing address

811 BRONX RIVER RD APT 2G
BRONXVILLE NY
10708-8022
US

V. Phone/Fax

Practice location:
  • Phone: 347-843-7760
  • Fax:
Mailing address:
  • Phone: 909-961-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number002327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: