Provider Demographics
NPI:1306028873
Name:MONTANEZ, BRENDA LIZETTE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LIZETTE
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:LIZETTE
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:171 E ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3447
Mailing Address - Country:US
Mailing Address - Phone:562-852-5755
Mailing Address - Fax:
Practice Address - Street 1:9829 CARMENITA RD STE H
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3262
Practice Address - Country:US
Practice Address - Phone:562-907-7429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW30241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health