Provider Demographics
NPI:1174923981
Name:MONTEMAYOR, BETTY (ACSW)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:A
Other - Last Name:MONTEMAYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 EL DORADO HILLS BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4481
Mailing Address - Country:US
Mailing Address - Phone:559-356-8141
Mailing Address - Fax:
Practice Address - Street 1:3440 EL DORADO HILLS BLVD APT 103
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4481
Practice Address - Country:US
Practice Address - Phone:559-356-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA947011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical