Provider Demographics
NPI:1740689223
Name:MUNTANER, NELLIE M
Entity type:Individual
Prefix:
First Name:NELLIE
Middle Name:M
Last Name:MUNTANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BARALT I4
Mailing Address - Street 2:AVE PRINCIPAL
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0000
Mailing Address - Country:US
Mailing Address - Phone:787-556-8315
Mailing Address - Fax:787-957-8856
Practice Address - Street 1:URB. BARALT I4
Practice Address - Street 2:AVE PRINCIPAL
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-0000
Practice Address - Country:US
Practice Address - Phone:787-556-8315
Practice Address - Fax:787-957-8856
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR149481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20483OtherPROFESSIONAL SERVICES