Provider Demographics
NPI:1154048429
Name:MONTEMOR, AGOSTINHO ANTONIO III
Entity type:Individual
Prefix:
First Name:AGOSTINHO
Middle Name:ANTONIO
Last Name:MONTEMOR
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7987
Mailing Address - Country:US
Mailing Address - Phone:360-348-0794
Mailing Address - Fax:
Practice Address - Street 1:2621 BICKFORD AVE STE C
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1736
Practice Address - Country:US
Practice Address - Phone:360-217-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst