MEDICARE: MS. DENISE MONTGOMERY LICSW, LCSW-C, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC50078080	DC

General Provider Information

NPI Number	:	1821162009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE MONTGOMERY LICSW, LCSW-C, LMFT

Provider Business Mailing Address
First Line	:	2942 CHARREDWOOD DR
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-2791
Country	:	US
Telephone Number	:	202-423-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4329 NORTHVIEW DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-2601
Country	:	US
Telephone Number	:	202-423-0040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/26/2022

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