Provider Demographics
NPI:1346354594
Name:MONTIEL-FERNANDEZ, EULICES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EULICES
Middle Name:
Last Name:MONTIEL-FERNANDEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 AMBOY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2469
Mailing Address - Country:US
Mailing Address - Phone:732-887-0037
Mailing Address - Fax:732-321-1975
Practice Address - Street 1:320 AMBOY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2469
Practice Address - Country:US
Practice Address - Phone:732-887-0037
Practice Address - Fax:732-321-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052136001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074209Medicare ID - Type Unspecified