Provider Demographics
NPI:1205138583
Name:MONTONEY, MICHELLE ELISE (LCPC-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELISE
Last Name:MONTONEY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2602
Mailing Address - Country:US
Mailing Address - Phone:207-468-0340
Mailing Address - Fax:
Practice Address - Street 1:1486 BROADWAY
Practice Address - Street 2:UNIT B
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2602
Practice Address - Country:US
Practice Address - Phone:207-468-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3640101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor