Provider Demographics
NPI:1700428125
Name:MONTEIRO, RAMON MICHAEL (CASAC-2)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:MICHAEL
Last Name:MONTEIRO
Suffix:
Gender:M
Credentials:CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2114
Mailing Address - Country:US
Mailing Address - Phone:631-852-1070
Mailing Address - Fax:
Practice Address - Street 1:550 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2114
Practice Address - Country:US
Practice Address - Phone:631-852-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)