Provider Demographics
NPI:1548018500
Name:MONTIEL, KELLY MARILYN (LMSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARILYN
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FRANKLIN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3683
Mailing Address - Country:US
Mailing Address - Phone:845-500-0413
Mailing Address - Fax:
Practice Address - Street 1:50 DAYTON LN STE 205
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2860
Practice Address - Country:US
Practice Address - Phone:914-736-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker