Provider Demographics
NPI:1871972489
Name:MONTGOMERY, MONICA L (LCSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-8740
Mailing Address - Country:US
Mailing Address - Phone:970-218-9341
Mailing Address - Fax:970-788-7418
Practice Address - Street 1:224 POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8740
Practice Address - Country:US
Practice Address - Phone:970-218-9341
Practice Address - Fax:970-788-7418
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5701041C0700X
COCSW.099241781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88920054Medicaid