Provider Demographics
NPI:1134355480
Name:MONTALVO, LUIS DANIEL (MSW)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:DANIEL
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 82ND ST
Mailing Address - Street 2:APT. 6B
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1444
Mailing Address - Country:US
Mailing Address - Phone:347-451-4401
Mailing Address - Fax:
Practice Address - Street 1:4404 QUEENS BLVD
Practice Address - Street 2:2ND FL.
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2406
Practice Address - Country:US
Practice Address - Phone:718-706-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker