Provider Demographics
NPI:1073298089
Name:MONTEZ, DEIRDRE A (CADC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:A
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 KINDERKAMACK RD APT N4
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-2090
Mailing Address - Country:US
Mailing Address - Phone:201-993-7807
Mailing Address - Fax:
Practice Address - Street 1:215 KINDERKAMACK RD APT N4
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-2090
Practice Address - Country:US
Practice Address - Phone:201-993-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00179700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)