Provider Demographics
NPI:1588382808
Name:MONTENORA, MELANIE ANN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:MONTENORA
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 1:181 WATERS EDGE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1326
Mailing Address - Country:US
Mailing Address - Phone:646-265-9022
Mailing Address - Fax:
Practice Address - Street 1:181 WATERS EDGE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-1326
Practice Address - Country:US
Practice Address - Phone:646-265-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-21-53822103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst