Provider Demographics
NPI:1225395577
Name:MONTGOMERY, ROBERT JAMES (LADC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:38 OLD RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5128
Mailing Address - Country:US
Mailing Address - Phone:203-792-4515
Mailing Address - Fax:203-748-2604
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:SUITE 2104
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-482-3613
Practice Address - Fax:860-482-2638
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT227101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)