Provider Demographics
NPI:1679082895
Name:MONTANO-ROMERO, LARISA NADEZHDA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:NADEZHDA
Last Name:MONTANO-ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 JENSCOT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9013
Mailing Address - Country:US
Mailing Address - Phone:407-361-7233
Mailing Address - Fax:
Practice Address - Street 1:2544 JENSCOT ROAD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771
Practice Address - Country:US
Practice Address - Phone:407-361-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst