Provider Demographics
NPI:1407746308
Name:MONTALVO, LISETTE M (MA, LGPC)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:M
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 BELTSVILLE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3121
Mailing Address - Country:US
Mailing Address - Phone:240-389-1487
Mailing Address - Fax:
Practice Address - Street 1:11785 BELTSVILLE DR STE 120
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3121
Practice Address - Country:US
Practice Address - Phone:240-389-1487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP15916101YA0400X, 101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional