Provider Demographics
NPI:1366757304
Name:FORDYCE-MONTANARI, PATRICIA DIANE (LMHC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:FORDYCE-MONTANARI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-1362
Mailing Address - Country:US
Mailing Address - Phone:505-333-2334
Mailing Address - Fax:
Practice Address - Street 1:11 COUNTY ROAD 2952
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9770
Practice Address - Country:US
Practice Address - Phone:505-333-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0132941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health