MEDICARE: PATRICIA RAVEN MONTAGUE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW143144	PA

General Provider Information

NPI Number	:	1174406383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RAVEN MONTAGUE LSW

Provider Business Mailing Address
First Line	:	401 N HIGHLAND AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-2926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 W ALLEGHENY RD
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9770
Country	:	US
Telephone Number	:	724-695-8979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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