Provider Demographics
NPI:1841035458
Name:MAYSONET MONTALVO, MARIA ELENA (LCDA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MAYSONET MONTALVO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:MAYSONET MONTALVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:A9 CALLE 1
Mailing Address - Street 2:URB EL NARANJAL
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-0000
Mailing Address - Country:US
Mailing Address - Phone:787-674-0763
Mailing Address - Fax:
Practice Address - Street 1:A9 CALLE 1
Practice Address - Street 2:URB EL NARANJAL
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-674-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist