Provider Demographics
NPI:1851828693
Name:MONTOYA, OLSEN (LMSW)
Entity type:Individual
Prefix:
First Name:OLSEN
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 BROADWAY
Mailing Address - Street 2:408
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1606
Mailing Address - Country:US
Mailing Address - Phone:917-213-2422
Mailing Address - Fax:
Practice Address - Street 1:5009 BROADWAY
Practice Address - Street 2:408
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1606
Practice Address - Country:US
Practice Address - Phone:917-213-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083332104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker