MEDICARE: ALLISON BETH MONTGOMERY LCSW

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	34004402A	IN

General Provider Information

NPI Number	:	1922234020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON BETH MONTGOMERY LCSW

Provider Business Mailing Address
First Line	:	160 WEST 44TH STREET
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 WEST 44TH STREET
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-0000
Country	:	US
Telephone Number	:	317-698-6971
Fax Number	:

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

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	09/03/2009

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