Provider Demographics
NPI:1003616707
Name:MONTES, MAURICIO (MA)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:MONTES
Suffix:
Gender:X
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SUTHERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7100
Mailing Address - Country:US
Mailing Address - Phone:631-560-2702
Mailing Address - Fax:
Practice Address - Street 1:800 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-1900
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling