Healthcare Provider Details

I. General information

NPI: 1174543755
Provider Name (Legal Business Name): MOLLIE ANNIE MONTGOMERY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MAIN ST
GREENFIELD MA
01301-3269
US

IV. Provider business mailing address

9 EASTERN AVE
SOUTH DEERFIELD MA
01373-1110
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-6100
  • Fax:
Mailing address:
  • Phone: 413-665-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5947
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: