Provider Demographics
NPI:1497226740
Name:MONTEAGUDO, DIEGO
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:MONTEAGUDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LEFFINGWELL PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2404
Mailing Address - Country:US
Mailing Address - Phone:914-469-6373
Mailing Address - Fax:
Practice Address - Street 1:6 LEFFINGWELL PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2404
Practice Address - Country:US
Practice Address - Phone:914-469-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool