MEDICARE: GRACE KELLY MONTECER

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	103K00000X	Behavior Analyst	002327	NY

General Provider Information

NPI Number	:	1154984813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE KELLY MONTECER

Provider Business Mailing Address
First Line	:	811 BRONX RIVER RD APT 2G
Second Line	:
City	:	BRONXVILLE
State	:	NY
Zip	:	10708-8022
Country	:	US
Telephone Number	:	909-961-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BENCHLEY PL FRNT 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-3402
Country	:	US
Telephone Number	:	347-843-7760
Fax Number	:

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	05/01/2026

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Directions to “ GRACE KELLY MONTECER ” Practice Location

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