Provider Demographics
NPI:1730851023
Name:MONTELIONE, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MONTELIONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1202
Mailing Address - Country:US
Mailing Address - Phone:631-252-6567
Mailing Address - Fax:
Practice Address - Street 1:55 CONCORD ST STE 204
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2646
Practice Address - Country:US
Practice Address - Phone:875-277-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089740-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical