Provider Demographics
NPI:1548507312
Name:MONTOLIO, JOSEPH L (LCADC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MONTOLIO
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:L
Other - Last Name:MONTOLIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:32 COLONIA PL
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3906
Mailing Address - Country:US
Mailing Address - Phone:732-396-9626
Mailing Address - Fax:
Practice Address - Street 1:32 COLONIA PL
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3906
Practice Address - Country:US
Practice Address - Phone:732-396-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00178600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)