Provider Demographics
NPI:1598074148
Name:MONTANEZ, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MONTANEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SCRANTON POCONO HWY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2274
Mailing Address - Country:US
Mailing Address - Phone:570-344-5253
Mailing Address - Fax:570-800-7402
Practice Address - Street 1:125 SCRANTON POCONO HWY
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2274
Practice Address - Country:US
Practice Address - Phone:570-344-5253
Practice Address - Fax:570-800-7402
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA357250101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)