Provider Demographics
NPI:1568918761
Name:MONTOYA, JOSE E (LCSWA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 COMET CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4555
Mailing Address - Country:US
Mailing Address - Phone:336-944-2554
Mailing Address - Fax:
Practice Address - Street 1:2740 PROSPERITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4354
Practice Address - Country:US
Practice Address - Phone:703-321-2600
Practice Address - Fax:703-321-2603
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0107981041C0700X
VA09040106521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical