Provider Demographics
NPI:1881804771
Name:PEREZMONTALVO, JAIME A (LISW)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:A
Last Name:PEREZMONTALVO
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STOWELL ST
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9705
Mailing Address - Country:US
Mailing Address - Phone:413-586-8753
Mailing Address - Fax:
Practice Address - Street 1:1985 MAIN ST
Practice Address - Street 2:VET CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1095
Practice Address - Country:US
Practice Address - Phone:413-737-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA038941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical