Provider Demographics
NPI:1497802870
Name:MONTGOMERY, B ALICIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:B
Middle Name:ALICIA
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MACARTHUR BLVD APT 41
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2941
Mailing Address - Country:US
Mailing Address - Phone:510-969-9361
Mailing Address - Fax:
Practice Address - Street 1:3725 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3308
Practice Address - Country:US
Practice Address - Phone:510-969-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical