Provider Demographics
NPI:1396193124
Name:MONTOYA, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COMMONWEALTH AVE APT TH17
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1058
Mailing Address - Country:US
Mailing Address - Phone:774-254-7586
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5520
Practice Address - Country:US
Practice Address - Phone:617-325-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health