Provider Demographics
NPI:1821505033
Name:MONTENEGRO, YUDITH DEL CARMEN (BA)
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:DEL CARMEN
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4128
Mailing Address - Country:US
Mailing Address - Phone:305-303-4266
Mailing Address - Fax:
Practice Address - Street 1:144 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4128
Practice Address - Country:US
Practice Address - Phone:305-303-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician