Provider Demographics
NPI:1700085016
Name:MONTAINI-KLOVDAHL, LUISA (PHD, CPT)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:MONTAINI-KLOVDAHL
Suffix:
Gender:F
Credentials:PHD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4140
Mailing Address - Country:US
Mailing Address - Phone:650-384-6559
Mailing Address - Fax:
Practice Address - Street 1:4153 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-4140
Practice Address - Country:US
Practice Address - Phone:650-384-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15659103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent