Provider Demographics
NPI:1558622456
Name:ALVAREZ-MONTOYA, JESSICA RENEE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RENEE
Last Name:ALVAREZ-MONTOYA
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 LARCHMONT ACRES APT A
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-7317
Mailing Address - Country:US
Mailing Address - Phone:914-338-6338
Mailing Address - Fax:
Practice Address - Street 1:325 LARCHMONT ACRES
Practice Address - Street 2:APT 5A
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-7317
Practice Address - Country:US
Practice Address - Phone:914-338-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816103171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor