Healthcare Provider Details

I. General information

NPI: 1265520258
Provider Name (Legal Business Name): M. JOSEPH MONTI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W GENESEE ST SUITE 118
CAMILLUS NY
13031-3200
US

IV. Provider business mailing address

5700 W GENESEE ST SUITE 118
CAMILLUS NY
13031-3200
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-1641
  • Fax: 315-488-1655
Mailing address:
  • Phone: 315-488-1641
  • Fax: 315-488-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRY ANNE MONTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-488-1641