Provider Demographics
NPI:1811676026
Name:MONTALVO, GLORIMAR
Entity type:Individual
Prefix:MRS
First Name:GLORIMAR
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GLORIMAR
Other - Middle Name:
Other - Last Name:MONTALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VILLA DEL CARMEN
Mailing Address - Street 2:914 CALLE SAMARIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:939-242-6819
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION VILLA DEL CARMEN
Practice Address - Street 2:914 CALLE SAMARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:193-924-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR164941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical