MEDICARE: MR. KENNY MONTEIRO M.ED

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

General Provider Information

NPI Number	:	1568116416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNY MONTEIRO M.ED

Provider Business Mailing Address
First Line	:	39 ORCHARD AVE
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-2301
Country	:	US
Telephone Number	:	774-422-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 FOREST AVE
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-5633
Country	:	US
Telephone Number	:	774-398-9270
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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