Provider Demographics
NPI:1417972506
Name:MONTGOMERY, CARI NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CARI
Middle Name:NICOLE
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 1:4913 GRACELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3426
Mailing Address - Country:US
Mailing Address - Phone:317-721-1166
Mailing Address - Fax:317-663-2951
Practice Address - Street 1:23 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2632
Practice Address - Country:US
Practice Address - Phone:317-674-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0112291041C0700X
IN34005703A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201163980Medicaid
IN201178980AMedicaid
ININ1231OtherMEDICARE GROUP