Healthcare Provider Details

I. General information

NPI: 1285853770
Provider Name (Legal Business Name): MICHELE A MONTENEGRO LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CHAMBERSBURG ST
GETTYSBURG PA
17325-1120
US

IV. Provider business mailing address

90 HERRS RIDGE RD
GETTYSBURG PA
17325-8032
US

V. Phone/Fax

Practice location:
  • Phone: 240-301-2443
  • Fax:
Mailing address:
  • Phone: 443-310-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020486
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12348
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier12348
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerMARYLAND DEPARTMENT OF HEALTH
# 2
IdentifierCW020486
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: