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General NPI Number Information
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NPI Number | 1194697201
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH PHYSICIAN PLLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 2013 CEDARBRIDGE AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7050
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Country | US
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Telephone | 212-734-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 11 S UNION ST
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City | CAMBRIDGE
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State | NY
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Zip | 12816-1008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL MONTVILLE
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Credential |
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Telephone | 612-805-7008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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