Provider Demographics
NPI:1790061299
Name:MONTEIRO, LUCIANA DIAS
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:DIAS
Last Name:MONTEIRO
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 1:1600 W CAMPBELL AVE
Mailing Address - Street 2:102
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1526
Mailing Address - Country:US
Mailing Address - Phone:408-871-4924
Mailing Address - Fax:
Practice Address - Street 1:16264 CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7130
Practice Address - Country:US
Practice Address - Phone:408-779-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75265106H00000X
CALMFT 94701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist