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General NPI Number Information
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NPI Number | 1811210768
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Entity Type | Individual
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Provider Name | KATRELLIA MONTAGUE LCSW, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 506 W 145TH ST PMB 7
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City | NEW YORK
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State | NY
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Zip | 10031-5403
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Country | US
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Telephone | 917-744-5496
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Fax | 919-771-2050
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Provider Business Mailing Address
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Address Line | 4205 BAY RUM LN
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City | RALEIGH
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State | NC
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Zip | 27610-6183
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Country | US
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Telephone | 919-771-2010
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Fax | 919-771-2050
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R012889
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License Number State | NY
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