Provider Demographics
NPI:1174689368
Name:MONTEMURRO, LARRY P (PHD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:P
Last Name:MONTEMURRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1732
Mailing Address - Country:US
Mailing Address - Phone:724-423-6217
Mailing Address - Fax:724-423-1827
Practice Address - Street 1:902 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1732
Practice Address - Country:US
Practice Address - Phone:724-423-6217
Practice Address - Fax:724-423-1827
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-00-7237-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical