MEDICARE: MARITZA MONTANO LMHC

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	101YM0800X	Mental Health Counselor	MH0002669	FL

General Provider Information

NPI Number	:	1518086958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA MONTANO LMHC

Provider Business Mailing Address
First Line	:	PO BOX 415062
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5062
Country	:	US
Telephone Number	:	305-822-1600
Fax Number	:	305-818-2387

Provider Business Practice Location Address
First Line	:	16969 NW 67TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4214
Country	:	US
Telephone Number	:	305-822-1600
Fax Number	:	305-818-2387

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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