Provider Demographics
NPI:1891389193
Name:MONTENEGRO ACOSTA, JUDITH NEIVIS
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:NEIVIS
Last Name:MONTENEGRO ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 WINTER SHADE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8165
Mailing Address - Country:US
Mailing Address - Phone:407-558-5492
Mailing Address - Fax:
Practice Address - Street 1:7513 WINTER SHADE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8165
Practice Address - Country:US
Practice Address - Phone:407-558-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician