MEDICARE: MICHELE A MONTENEGRO LCSW-C

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	1041C0700X	Clinical Social Worker	CW020486	PA
2	1041C0700X	Clinical Social Worker	12348	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12348	OTHER	MD	MARYLAND DEPARTMENT OF HEALTH
2	CW020486	OTHER	PA	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU

General Provider Information

NPI Number	:	1285853770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE A MONTENEGRO LCSW-C

Provider Business Mailing Address
First Line	:	90 HERRS RIDGE RD
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-8032
Country	:	US
Telephone Number	:	443-310-9414
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 CHAMBERSBURG ST
Second Line	:
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-1120
Country	:	US
Telephone Number	:	240-301-2443
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/24/2022

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