Provider Demographics
NPI:1851329577
Name:MONTALTO, MARYJANE L (PSY D)
Entity Type:Individual
Prefix:DR
First Name:MARYJANE
Middle Name:L
Last Name:MONTALTO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-2808
Mailing Address - Country:US
Mailing Address - Phone:845-876-1241
Mailing Address - Fax:845-229-4038
Practice Address - Street 1:18-20 EAST MARKET STREET
Practice Address - Street 2:BOX 134
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1606
Practice Address - Country:US
Practice Address - Phone:845-876-1241
Practice Address - Fax:845-229-4038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015561-1103T00000X, 103TB0200X, 103TC2200X, 103TF0200X, 103TM1800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02784958Medicaid
NY11661034OtherCAQH
NY11661034OtherCAQH