MEDICARE: ROSALIE MONTOYA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	00649C	NV

General Provider Information

NPI Number	:	1043262397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIE MONTOYA LCSW

Provider Business Mailing Address
First Line	:	4538 W CRAIG RD
Second Line	:	SUITE 290
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2508
Country	:	US
Telephone Number	:	702-253-0818
Fax Number	:	702-253-9625

Provider Business Practice Location Address
First Line	:	4538 W CRAIG RD
Second Line	:	SUITE 290
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2508
Country	:	US
Telephone Number	:	702-253-0818
Fax Number	:	702-253-9625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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