Provider Demographics
NPI:1225158751
Name:MONTGOMERY BROSNAC, CAROL (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:MONTGOMERY BROSNAC
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 E 2ND ST # 582
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5324
Mailing Address - Country:US
Mailing Address - Phone:562-277-7868
Mailing Address - Fax:
Practice Address - Street 1:5318 E. 2ND STREET
Practice Address - Street 2:#582
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5324
Practice Address - Country:US
Practice Address - Phone:562-277-7868
Practice Address - Fax:888-534-1695
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT511900106H00000X
CAMFC 51190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT51190OtherBOARD OF BEHAVIORAL SCIENCES