Provider Demographics
NPI:1558753707
Name:MONTALVO, MERLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MERLE
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:MONTALVO
Other - Last Name:CHAFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 CONSTANCE LN APT 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5234
Mailing Address - Country:US
Mailing Address - Phone:662-574-3222
Mailing Address - Fax:
Practice Address - Street 1:212 CONSTANCE LN APT 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5234
Practice Address - Country:US
Practice Address - Phone:662-574-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC50311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical