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NPI Code Detail

MEDICARE: MS. SUSAN E MONTGOMERY LCSW-C

MEDICARE:  MS. SUSAN E MONTGOMERY  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
11041C0700XClinical Social Worker07751MD

General Provider Information

NPI Number : 1659389302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN E MONTGOMERY LCSW-C
Provider Business Mailing Address
First Line : 10108 EDWARD AVE
Second Line :
City : BETHESDA
State : MD
Zip : 20814-2116
Country : US
Telephone Number : 301-897-8815
Fax Number : 301-897-8815
Provider Business Practice Location Address
First Line : 3930 KNOWLES AVE
Second Line : SUITE 200
City : KENSINGTON
State : MD
Zip : 20895-2428
Country : US
Telephone Number : 301-897-8815
Fax Number : 301-897-8815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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Directions to “ MS. SUSAN E MONTGOMERY LCSW-C” Practice Location

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