Healthcare Provider Details

I. General information

NPI: 1760674972
Provider Name (Legal Business Name): NANCY K MONTAGNA PH. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 08/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 FIDLER LN #1417
SILVER SPRING MD
20910-3425
US

IV. Provider business mailing address

1110 FIDLER LN #1417
SILVER SPRING MD
20910-3425
US

V. Phone/Fax

Practice location:
  • Phone: 301-587-5735
  • Fax:
Mailing address:
  • Phone: 301-587-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number993
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number993
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number993
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number993
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number993
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number993
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: