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General NPI Number Information
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NPI Number | 1033275607
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Entity Type | Individual
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Provider Name | SUSANA Q. MONTALVO M.A.,M.S.ED.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 934 N MAGNOLIA AVE STE.119
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City | ORLANDO
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State | FL
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Zip | 32803-3840
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Country | US
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Telephone | 407-310-1273
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Fax | 407-677-6829
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Provider Business Mailing Address
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Address Line | 8537 BUCKLEY CT
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City | ORLANDO
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State | FL
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Zip | 32817-1664
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Country | US
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Telephone | 407-310-1273
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Fax | 407-677-6829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMHC2997
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License Number State | FL
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