Active NPI
Justin Montello
- Addiction (Substance Use Disorder) Counselor
- San Rafael, CA
National Provider Identifier
1730729781
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 103 Shoreline Pkwy Ste 201
San Rafael, CA 94901-5584 - Phone
- (415) 453-9980
- Fax
- (415) 453-6137
- NPI assigned
- Jan 7, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CA | Primary |
Addresses
Primary practice location
103 Shoreline Pkwy Ste 201
San Rafael, CA 94901-5584
Mailing address
6410 Schmidt LN Apt C202
El Cerrito, CA 94530-1949
Phone (425) 463-5711
Other practice location 1
171 Carlos Dr
San Rafael, CA 94903-2005
Phone (619) 356-1396
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770656704 | Medicaid | CA | |
| 1083069447 | Medicaid | CA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jmontello@bacr.org | Direct | Bay Area Community Resources, Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1730729781",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6410 SCHMIDT LN APT C202",
"city": "EL CERRITO",
"state": "CA",
"postal_code": "945301949",
"telephone_number": "425-463-5711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 SHORELINE PKWY STE 201",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949015584",
"telephone_number": "415-453-9980",
"fax_number": "415-453-6137"
}
],
"practiceLocations": [
{
"address_1": "171 Carlos Dr",
"address_purpose": "LOCATION",
"city": "San Rafael",
"state": "CA",
"postal_code": "949032005",
"country_code": "US",
"telephone_number": "619-356-1396",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MONTELLO",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-07",
"last_updated": "2023-11-27",
"certification_date": "2020-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1770656704",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083069447",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jmontello@bacr.org",
"affiliation": "Y",
"endpointDescription": "Bay Area Community Resources Email",
"affiliationName": "Bay Area Community Resources, Inc",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Work",
"address_1": "103 Shoreline Pkwy Ste 201",
"city": "San Rafael",
"state": "CA",
"country_code": "US",
"postal_code": "949015584",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.