Provider Demographics
NPI:1992907778
Name:MONTALVO, ADA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ADA
Middle Name:M
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 S LONGFELLOW CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4932
Mailing Address - Country:US
Mailing Address - Phone:954-964-7804
Mailing Address - Fax:
Practice Address - Street 1:3509 S LONGFELLOW CIR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4932
Practice Address - Country:US
Practice Address - Phone:954-964-7804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0038991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical