MEDICARE: TAMIKA A. MONTAGUE 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	CW021656	PA

General Provider Information

NPI Number	:	1982298857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIKA A. MONTAGUE LCSW

Provider Business Mailing Address
First Line	:	207 MARGATE RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-4611
Country	:	US
Telephone Number	:	215-651-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 HAVERFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2825
Country	:	US
Telephone Number	:	484-466-9597
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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