Provider Demographics
NPI:1437450731
Name:MONTANARI, PHYLLIS ARLENE (MA, LCAT, MT-BC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ARLENE
Last Name:MONTANARI
Suffix:
Gender:F
Credentials:MA, LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 STATE ROUTE 416
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549
Mailing Address - Country:US
Mailing Address - Phone:845-457-5424
Mailing Address - Fax:
Practice Address - Street 1:228 STATE ROUTE 416
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549
Practice Address - Country:US
Practice Address - Phone:845-457-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000194225A00000X
00902225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist