Provider Demographics
NPI:1255570131
Name:MONTOYA, EDUARDO (PSYD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W171 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6078
Mailing Address - Country:US
Mailing Address - Phone:630-909-7000
Mailing Address - Fax:630-909-7001
Practice Address - Street 1:18181 OAKWOOD BLVD STE 411
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4082
Practice Address - Country:US
Practice Address - Phone:248-551-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical