Provider Demographics
NPI:1821669961
Name:MONTANO, DANIEL (BCBA 1-23-65225)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MONTANO
Suffix:
Gender:M
Credentials:BCBA 1-23-65225
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 DANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5772
Mailing Address - Country:US
Mailing Address - Phone:954-774-3363
Mailing Address - Fax:
Practice Address - Street 1:3721 19TH ST SW
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-3317
Practice Address - Country:US
Practice Address - Phone:954-774-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
BCBA-1-23-65225103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110995800Medicaid