Provider Demographics
NPI:1538833629
Name:MONTERO, JACQUELINE (CSAC, ICRC, LMHC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MONTERO
Suffix:
Gender:F
Credentials:CSAC, ICRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 AOLOA ST APT A232
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3056
Mailing Address - Country:US
Mailing Address - Phone:808-861-7527
Mailing Address - Fax:
Practice Address - Street 1:350 AOLOA ST APT A232
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3056
Practice Address - Country:US
Practice Address - Phone:808-861-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2065-19101YA0400X
HIMHC-915101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional