Provider Demographics
NPI:1568116416
Name:MONTEIRO, KENNY (MED)
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:
Last Name:MONTEIRO
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2301
Mailing Address - Country:US
Mailing Address - Phone:774-422-9200
Mailing Address - Fax:
Practice Address - Street 1:470 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5633
Practice Address - Country:US
Practice Address - Phone:774-398-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health