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NPI Code Detail

MEDICARE: MS. BETHANY SOMES MONTGOMERY M.S.W., L.I.C.S.W.

MEDICARE:  MS. BETHANY SOMES MONTGOMERY  M.S.W., L.I.C.S.W.
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
11041C0700XClinical Social Worker1025571MA

General Provider Information

NPI Number : 1245389543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETHANY SOMES MONTGOMERY M.S.W., L.I.C.S.W.
Provider Business Mailing Address
First Line : 5 RAYMOND ST
Second Line :
City : LEXINGTON
State : MA
Zip : 02421-4945
Country : US
Telephone Number : 781-405-5445
Fax Number :
Provider Business Practice Location Address
First Line : 5 RAYMOND ST
Second Line :
City : LEXINGTON
State : MA
Zip : 02421-4945
Country : US
Telephone Number : 781-405-5445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 07/09/2007

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Directions to “ MS. BETHANY SOMES MONTGOMERY M.S.W., L.I.C.S.W.” Practice Location

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