Healthcare Provider Details

I. General information

NPI: 1114039294
Provider Name (Legal Business Name): ELIZABETH WERTZ MONTSERAT MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 NW HAWTHORNE AVE SUITE 105
BEND OR
97701-2929
US

IV. Provider business mailing address

61933 BROKENTOP DR
BEND OR
97702-1085
US

V. Phone/Fax

Practice location:
  • Phone: 541-788-5280
  • Fax: 541-382-7233
Mailing address:
  • Phone: 541-788-5280
  • Fax: 541-382-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3391
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: