Provider Demographics
NPI:1912916826
Name:MONTELEONE, JOSEPH (LMHC, LMFT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MONTELEONE
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-0086
Mailing Address - Country:US
Mailing Address - Phone:813-624-9299
Mailing Address - Fax:813-653-1122
Practice Address - Street 1:150 E BLOOMINGDALE AVE
Practice Address - Street 2:SUITE111
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8151
Practice Address - Country:US
Practice Address - Phone:813-624-9299
Practice Address - Fax:813-653-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2222106H00000X
FLMH6390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761405500Medicaid