1629403464 NPI number — MISS NATALIE GRACE MONTALDI MSW

Table of content: MISS NATALIE GRACE MONTALDI MSW (NPI 1629403464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629403464 NPI number — MISS NATALIE GRACE MONTALDI MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTALDI
Provider First Name:
NATALIE
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629403464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
892 LITTLE BEND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-7535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-994-0119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 MAITLAND CENTER COMMONS BLVD
Provider Second Line Business Practice Location Address:
#212
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751-7270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-636-3530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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