Provider Demographics
NPI:1679329163
Name:MONTOYA, GLORIA ELIZABETH (MA,LAC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ELIZABETH
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EAGLE ROCK VLG APT 1A
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-3336
Mailing Address - Country:US
Mailing Address - Phone:973-727-3665
Mailing Address - Fax:
Practice Address - Street 1:36 EAGLE ROCK VLG APT 1A
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828-3336
Practice Address - Country:US
Practice Address - Phone:973-727-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00788800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health