Provider Demographics
NPI:1538603634
Name:MONTANYE, ERICA (CAS)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MONTANYE
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 COUNTY ROAD 367
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-6582
Mailing Address - Country:US
Mailing Address - Phone:210-215-4403
Mailing Address - Fax:
Practice Address - Street 1:1 FARM LN # 458
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NJ
Practice Address - Zip Code:08555-9800
Practice Address - Country:US
Practice Address - Phone:609-490-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCAS169394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician