Provider Demographics
NPI:1467817064
Name:MONTALVO, JUAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5011
Mailing Address - Country:US
Mailing Address - Phone:203-777-2522
Mailing Address - Fax:
Practice Address - Street 1:645 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5011
Practice Address - Country:US
Practice Address - Phone:203-777-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTUNKNOWNMedicaid