Provider Demographics
NPI:1013786441
Name:MONTFORT, ERICH
Entity Type:Individual
Prefix:
First Name:ERICH
Middle Name:
Last Name:MONTFORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 W CANAL RD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2101
Mailing Address - Country:US
Mailing Address - Phone:585-353-2150
Mailing Address - Fax:
Practice Address - Street 1:8055 W CANAL RD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2101
Practice Address - Country:US
Practice Address - Phone:585-353-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health