MEDICARE: CRYSTAL MONTGOMERY LICSW, 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	34290	MD
2	1041C0700X	Clinical Social Worker	200002740	DC

General Provider Information

NPI Number	:	1790617397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MONTGOMERY LICSW, LCSW-C

Provider Business Mailing Address
First Line	:	5661 3RD ST NE APT 479
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2575
Country	:	US
Telephone Number	:	917-627-5723
Fax Number	:

Provider Business Practice Location Address
First Line	:	5661 3RD ST NE APT 479
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2575
Country	:	US
Telephone Number	:	917-627-5723
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ CRYSTAL MONTGOMERY LICSW, LCSW-C” Practice Location

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