Provider Demographics
NPI:1831463603
Name:MONTALVO, HEDY M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEDY
Middle Name:M
Last Name:MONTALVO
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 1:21 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3330
Mailing Address - Country:US
Mailing Address - Phone:631-807-9152
Mailing Address - Fax:
Practice Address - Street 1:35 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5415
Practice Address - Country:US
Practice Address - Phone:631-807-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071084-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical