Provider Demographics
NPI:1467768408
Name:MONTESINO, MIGUEL ENRIQUE JR (MD)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ENRIQUE
Last Name:MONTESINO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PRESIDENTS WAY APT 3304
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4579
Mailing Address - Country:US
Mailing Address - Phone:617-548-1503
Mailing Address - Fax:
Practice Address - Street 1:20 EASTBROOK RD STE 201
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2087
Practice Address - Country:US
Practice Address - Phone:781-302-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical