Provider Demographics
NPI:1427629518
Name:MONTOYA, WILSON (MSW)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:WILSON
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4 OSAGE CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1517
Mailing Address - Country:US
Mailing Address - Phone:201-654-2553
Mailing Address - Fax:
Practice Address - Street 1:50 LASER CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3958
Practice Address - Country:US
Practice Address - Phone:631-853-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker