Provider Demographics
NPI:1700495405
Name:MONTOYA, ANTONIA PATRICE (LCSW)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:PATRICE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27191
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7191
Mailing Address - Country:US
Mailing Address - Phone:505-333-9336
Mailing Address - Fax:
Practice Address - Street 1:8831 4TH ST NW UNIT B
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87114-1407
Practice Address - Country:US
Practice Address - Phone:505-333-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2023-01441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical