Provider Demographics
NPI:1831923507
Name:MONTILLA, ALTAGRACIA
Entity type:Individual
Prefix:
First Name:ALTAGRACIA
Middle Name:
Last Name:MONTILLA
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 1:2255 STATE ROUTE 32 UNIT 619
Mailing Address - Street 2:
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548-7027
Mailing Address - Country:US
Mailing Address - Phone:845-200-9230
Mailing Address - Fax:845-622-3504
Practice Address - Street 1:263 ROUTE 17K STE 107A
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8345
Practice Address - Country:US
Practice Address - Phone:929-402-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker