Provider Demographics
NPI:1558013425
Name:MONTEIRO, DAMASCENO
Entity type:Individual
Prefix:
First Name:DAMASCENO
Middle Name:
Last Name:MONTEIRO
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 1:9 CENTENNIAL DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7940
Mailing Address - Country:US
Mailing Address - Phone:617-790-4800
Mailing Address - Fax:
Practice Address - Street 1:9 CENTENNIAL DR UNIT 101
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7940
Practice Address - Country:US
Practice Address - Phone:617-790-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health