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1407746308

NPI Code Detail

MEDICARE: LISETTE M MONTALVO MA, LGPC

MEDICARE: LISETTE M MONTALVO MA, LGPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LGP15916	MD
2	101YM0800X	Mental Health Counselor	LGP15916	MD
3	101YP2500X	Professional Counselor	LGP15916	MD
4	101Y00000X	Counselor	LGP15916	MD

General Provider Information

NPI Number	:	1407746308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETTE M MONTALVO MA, LGPC

Provider Business Mailing Address
First Line	:	11785 BELTSVILLE DR STE 120
Second Line	:
City	:	CALVERTON
State	:	MD
Zip	:	20705-3121
Country	:	US
Telephone Number	:	240-389-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	11785 BELTSVILLE DR STE 120
Second Line	:
City	:	CALVERTON
State	:	MD
Zip	:	20705-3121
Country	:	US
Telephone Number	:	240-389-1487
Fax Number	:

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

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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Directions to “ LISETTE M MONTALVO MA, LGPC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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