Provider Demographics
NPI:1528196797
Name:MONTANEZ, DURANDA COSETTE (PHD)
Entity Type:Individual
Prefix:
First Name:DURANDA
Middle Name:COSETTE
Last Name:MONTANEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DURANDA
Other - Middle Name:COSETTE
Other - Last Name:ORELLANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 249
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1206
Mailing Address - Country:US
Mailing Address - Phone:505-527-5823
Mailing Address - Fax:505-527-5886
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:SUITE 249
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1206
Practice Address - Country:US
Practice Address - Phone:505-527-5823
Practice Address - Fax:505-527-5886
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
NM0944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other