Organization Active NPI

Jean M. Monty PHD Psychological Services LLC

  • Psychologist
  • Mequon, WI
National Provider Identifier
1861790933
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1880 Issued in WI
Legal business name
JEAN M. MONTY PHD PSYCHOLOGICAL SERVICES LLC
Practice address
14135 N Cedarburg Rd
Mequon, WI 53097-1416
Phone
(262) 377-2006
Fax
(262) 377-5552
NPI assigned
Mar 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Authorized official

Name
Dr. Jean Marie Monty, PHDNPI 1417001579
Title
Psychologist
Phone
(262) 377-2006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 1880 WI Primary

Addresses

Primary practice location

14135 N Cedarburg Rd
Mequon, WI 53097-1416

Mailing address

14135 N Cedarburg Rd
Mequon, WI 53097-1416
Phone (262) 377-2006

Other identifiers 1

IdentifierTypeStateIssuer
1417001579MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110329000899 WI Part B Supplier - Clinic/Group Practice 2163605163 Receives reassigned benefits from 1 practitioner
Practice locations: Mequon, WI

National Provider Directory

National Provider Directory

Locations

10144 N Port Washington Rd
Ste 1G
Mequon, WI 53092
Phone (262) 302-4126

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1300060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1861790933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14135 N CEDARBURG RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530971416",
            "telephone_number": "262-377-2006",
            "fax_number": "262-377-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14135 N CEDARBURG RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530971416",
            "telephone_number": "262-377-2006",
            "fax_number": "262-377-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN M. MONTY PHD PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-14",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "MONTY",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "262-377-2006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417001579",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.