Healthcare Provider Details

I. General information

NPI: 1487576294
Provider Name (Legal Business Name): JENNIFER ALICIA MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10812 38TH AVE APT 2R
CORONA NY
11368-5546
US

IV. Provider business mailing address

10812 38TH AVE APT 2R
CORONA NY
11368-5546
US

V. Phone/Fax

Practice location:
  • Phone: 347-730-0481
  • Fax:
Mailing address:
  • Phone: 347-730-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1234
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: