Provider Demographics
NPI:1801225461
Name:MONTEMAYOR, PAULINE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:MONTEMAYOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 BROAD ST APT K4
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2859
Mailing Address - Country:US
Mailing Address - Phone:973-670-2968
Mailing Address - Fax:
Practice Address - Street 1:129 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2331
Practice Address - Country:US
Practice Address - Phone:862-210-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056116001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical