Provider Demographics
NPI:1417790593
Name:MONTALTO, MICHALINA GIOVANNA
Entity type:Individual
Prefix:
First Name:MICHALINA
Middle Name:GIOVANNA
Last Name:MONTALTO
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 1:2802 RWS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8863
Mailing Address - Country:US
Mailing Address - Phone:863-368-7538
Mailing Address - Fax:
Practice Address - Street 1:2802 RWS RANCH RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8863
Practice Address - Country:US
Practice Address - Phone:863-368-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty