Provider Demographics
NPI:1285853770
Name:MONTENEGRO, MICHELE A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HERRS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8032
Mailing Address - Country:US
Mailing Address - Phone:443-310-9414
Mailing Address - Fax:
Practice Address - Street 1:204 CHAMBERSBURG ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1120
Practice Address - Country:US
Practice Address - Phone:240-301-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0204861041C0700X
MD123481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12348OtherMARYLAND DEPARTMENT OF HEALTH
PACW020486OtherCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU