Provider Demographics
NPI:1386879773
Name:MONTALVO, SUSANA (LMHC)
Entity type:Individual
Prefix:MISS
First Name:SUSANA
Middle Name:
Last Name:MONTALVO
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 1:12864 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5416
Mailing Address - Country:US
Mailing Address - Phone:305-225-7879
Mailing Address - Fax:305-820-8980
Practice Address - Street 1:6250 W 21ST CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2655
Practice Address - Country:US
Practice Address - Phone:305-820-8659
Practice Address - Fax:305-820-8980
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health