Provider Demographics
NPI:1447999131
Name:MONTANEZ AGOSTO, JOSE YAMIL (MSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:YAMIL
Last Name:MONTANEZ AGOSTO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J14 CALLE 10
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2145
Mailing Address - Country:US
Mailing Address - Phone:787-215-7897
Mailing Address - Fax:
Practice Address - Street 1:BO. MAMEY I CARR. 189 KM 8.2
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-961-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12870104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty