Provider Demographics
NPI:1659389302
Name:MONTGOMERY, SUSAN E (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:MONTGOMERY
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 1:10108 EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2116
Mailing Address - Country:US
Mailing Address - Phone:301-897-8815
Mailing Address - Fax:301-897-8815
Practice Address - Street 1:3930 KNOWLES AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:301-897-8815
Practice Address - Fax:301-897-8815
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD077511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0753531Medicare ID - Type Unspecified