MEDICARE: OLGA MONTGOMERY LCSW

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	0904015246	VA

General Provider Information

NPI Number	:	1912663469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA MONTGOMERY LCSW

Provider Business Mailing Address
First Line	:	9327 MIDLOTHIAN TPKE STE 2G
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4944
Country	:	US
Telephone Number	:	804-404-6008
Fax Number	:	804-414-7558

Provider Business Practice Location Address
First Line	:	9327 MIDLOTHIAN TPKE STE 2G
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4944
Country	:	US
Telephone Number	:	804-404-6008
Fax Number	:	804-414-7558

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	05/23/2025

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