=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740090307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHODIUM CARE GROUP OF PA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2025
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 BROOKMONT DR
-----------------------------------------------------
City | EFFORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18330-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-734-6621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2013 CEDARBRIDGE AVE STE 3D
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-7050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIEL MONTVILLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 612-805-7008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------