Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003228586 |
---|---|
Provider Name | Kelvin Montero |
First Address | College Point, NY 11356-1412 |
Second Address | Oakland Gardens, NY 11364-1049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 13/09/2018 |