Individual
GRACIELA MONTALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
1235 MONTAUK HWY, MASTIC, NY 11950-2917
(631) 647-2154
Mailing address
25 WOODLAWN AVE, SELDEN, NY 11784-3256
(631) 921-3941
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/10/2016
Last updated
08/27/2020
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