Provider Demographics
NPI:1487923074
Name:MONTANEZ, DOLORES (LCSW)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:
Other - Last Name:MONTANEZ-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:529 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5708
Mailing Address - Country:US
Mailing Address - Phone:210-452-4554
Mailing Address - Fax:210-618-0324
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:210-452-4554
Practice Address - Fax:210-618-0324
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315771041C0700X
COCSW099250781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151109Medicare PIN