Provider Demographics
NPI:1063906253
Name:MONTECALLO, CATHRYN EIIZABETH
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:EIIZABETH
Last Name:MONTECALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 WOODWILD DR
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4552
Mailing Address - Country:US
Mailing Address - Phone:732-581-9229
Mailing Address - Fax:
Practice Address - Street 1:813 WOODWILD DR
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4552
Practice Address - Country:US
Practice Address - Phone:732-581-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care