Provider Demographics
NPI:1396272506
Name:MONTEIRO, LENIRA IVANI
Entity type:Individual
Prefix:
First Name:LENIRA
Middle Name:IVANI
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LENIRA
Other - Middle Name:IVANI
Other - Last Name:DESOUSA OLIVEIRA BORGES MONTEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5476
Mailing Address - Country:US
Mailing Address - Phone:781-891-0556
Mailing Address - Fax:781-701-8905
Practice Address - Street 1:431 RIVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-891-0556
Practice Address - Fax:781-701-8905
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical