Individual provider Active NPI

Pamela Elaine Warner de Montoya, M.A., LMHC, C.A.G.S.

  • Mental Health Counselor
  • Charlestown, RI
National Provider Identifier
1376651935
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MHC00314 Issued in RI
Practice address
4705 Old Post Rd Unit a
Charlestown, RI 02813-1842
Phone
(401) 364-7705
Fax
(401) 364-9104
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MHC00314 RI Primary

Addresses

Primary practice location

4705 Old Post Rd Unit a
Charlestown, RI 02813-1842

Mailing address

PO Box 899
Charlestown, RI 02813-0899
Phone (401) 364-7705

Other identifiers 1

IdentifierTypeStateIssuer
PW85694MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 1, 2024 through Jan 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
MHC00314RIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Center Inc Mental Health Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1376651935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 899",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028130899",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 OLD POST RD UNIT A",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131842",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-9104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARNER DE MONTOYA",
        "first_name": "PAMELA",
        "middle_name": "ELAINE",
        "credential": "M.A., LMHC, C.A.G.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "MHC00314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PW85694",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlestown, RI

Sources for this page

Verify at the official NPI Registry.