Provider Demographics
NPI:1932812302
Name:MONTOYA, JUAN PABLO (LMSW)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:PABLO
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:PABLO
Other - Last Name:VILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 FASHION AVE FL 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVE
Practice Address - Street 2:18TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:212-582-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112000103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty