Provider Demographics
NPI:1861567315
Name:MONTERO, ELBA ALICIA (LCSW)
Entity type:Individual
Prefix:
First Name:ELBA ALICIA
Middle Name:
Last Name:MONTERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 13TH ST APT 33
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3746
Mailing Address - Country:US
Mailing Address - Phone:212-995-0312
Mailing Address - Fax:
Practice Address - Street 1:549 W 180TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-5825
Practice Address - Country:US
Practice Address - Phone:212-795-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052787251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAM0N0K4410Medicare ID - Type Unspecified