Healthcare Provider Details

I. General information

NPI: 1750740239
Provider Name (Legal Business Name): HEATHER MARIE MONTEMARANO LCAT, LPAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 BARTLETT AVE
STATEN ISLAND NY
10312-2101
US

IV. Provider business mailing address

393 BARTLETT AVE
STATEN ISLAND NY
10312-2101
US

V. Phone/Fax

Practice location:
  • Phone: 732-207-6925
  • Fax:
Mailing address:
  • Phone: 732-207-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16LP00023000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002428-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: