Provider Demographics
NPI:1285289090
Name:MONTOYA, CAROL A (SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509 TOLEDO ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4970
Mailing Address - Country:US
Mailing Address - Phone:505-280-0777
Mailing Address - Fax:
Practice Address - Street 1:4100 BARBARA LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1000
Practice Address - Country:US
Practice Address - Phone:505-702-8547
Practice Address - Fax:505-702-8604
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-11143101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor