Provider Demographics
NPI:1558495697
Name:MONTANO, ALEXANDRU (MA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRU
Middle Name:
Last Name:MONTANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2727 FOLSOM ST
Mailing Address - Street 2:APT 106
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3700
Mailing Address - Country:US
Mailing Address - Phone:720-470-7010
Mailing Address - Fax:
Practice Address - Street 1:2727 FOLSOM ST
Practice Address - Street 2:APT 106
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3700
Practice Address - Country:US
Practice Address - Phone:720-470-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 106H00000X
CO427931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist