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General NPI Number Information
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NPI Number | 1679096093
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Entity Type | Individual
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Provider Name | JOANNE LILLIAN MONTGOMERY LADC, MSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 57 PLAINS RD STE 1E
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City | MILFORD
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State | CT
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Zip | 06461-2573
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Country | US
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Telephone | 203-913-6439
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Fax |
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Provider Business Mailing Address
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Address Line | 11 VALLEY BROOK RD
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City | WEST HAVEN
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State | CT
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Zip | 06516-2946
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Country | US
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Telephone | 203-931-1593
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 001242
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License Number State | CT
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