Provider Demographics
NPI:1053009100
Name:MONTANEZ, ALYSSA ADRIANNA (RCSWI)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ADRIANNA
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 BLACKJACK RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5695
Mailing Address - Country:US
Mailing Address - Phone:321-948-9060
Mailing Address - Fax:
Practice Address - Street 1:1123 BLACKJACK RIDGE ST
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5695
Practice Address - Country:US
Practice Address - Phone:321-948-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW18645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker