Provider Demographics
NPI:1588401491
Name:MONTESINO, MARIEN
Entity type:Individual
Prefix:
First Name:MARIEN
Middle Name:
Last Name:MONTESINO
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 1:180 ROYAL PALM RD APT 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4635
Mailing Address - Country:US
Mailing Address - Phone:786-578-1893
Mailing Address - Fax:
Practice Address - Street 1:7500 NW 25TH ST STE 252
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1720
Practice Address - Country:US
Practice Address - Phone:305-903-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-351789106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician