Provider Demographics
NPI:1538697073
Name:MONTES, GRACE JOHANNA (MA, LPC)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:JOHANNA
Last Name:MONTES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:JOHANNA
Other - Last Name:MONTES VERGARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:154 CHILTON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1448
Mailing Address - Country:US
Mailing Address - Phone:908-230-3999
Mailing Address - Fax:
Practice Address - Street 1:220 LENOX AVE STE OFFICE5
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5101
Practice Address - Country:US
Practice Address - Phone:908-543-9100
Practice Address - Fax:201-624-7846
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-29
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00556100101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional