Provider Demographics
NPI:1336713007
Name:MONTES, SHIRLEY (CBHCM)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MONTES
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:J
Other - Last Name:MONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7010 NW 186TH ST APT 321
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3198
Mailing Address - Country:US
Mailing Address - Phone:956-617-1329
Mailing Address - Fax:
Practice Address - Street 1:14100 PALMETTO FRNTG RD STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1568
Practice Address - Country:US
Practice Address - Phone:786-463-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101763171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator