Provider Demographics
NPI:1477693992
Name:MONTEIRO, NICOLE MAISHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MAISHA
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 KENMORE AVE
Mailing Address - Street 2:#506
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1163
Mailing Address - Country:US
Mailing Address - Phone:571-242-3377
Mailing Address - Fax:202-331-4402
Practice Address - Street 1:2607 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1522
Practice Address - Country:US
Practice Address - Phone:202-331-4402
Practice Address - Fax:202-331-4402
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000332103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical