Healthcare Provider Details

I. General information

NPI: 1851329577
Provider Name (Legal Business Name): MARYJANE L. MONTALTO PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-20 EAST MARKET STREET BOX 134
RHINEBECK NY
12572-1606
US

IV. Provider business mailing address

99 MOUNTAIN VIEW RD
RHINEBECK NY
12572-2808
US

V. Phone/Fax

Practice location:
  • Phone: 845-876-1241
  • Fax: 845-229-4038
Mailing address:
  • Phone: 845-876-1241
  • Fax: 845-229-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number015561-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number015561-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number015561-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number015561-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number015561-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number015561-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: