Provider Demographics
NPI:1003155516
Name:MONTAGUE, STACIA (MSW, BSW,LMSW)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:MSW, BSW,LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:3RD FLOOR HOME BASED SERVICES
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-575-0466
Practice Address - Fax:203-575-1817
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNOT ELIGIBLEOtherMHN TRICARE
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CT008060347Medicaid
CT060669107OtherUBH CONNECTICARE WELLMORE GRP/FACILITY
CT060669107OtherUBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CT060669107OtherUNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CTNOT ELIGIBLEOtherMHN TRICARENORTH
CTNOT ELIGIBLEOtherMHN-MANAGED HEALTH NETWORK
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT13671439OtherCAQH
CTD3392029 WATERBURYOtherBEACON HEALTH STRATEGIES
CT060669107OtherUBH OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY