Provider Demographics
NPI:1710652136
Name:MONTGOMERY, KIM K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:K
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:PO BOX 91345
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1345
Mailing Address - Country:US
Mailing Address - Phone:505-507-0862
Mailing Address - Fax:
Practice Address - Street 1:3736 EUBANK BLVD NE STE B1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3583
Practice Address - Country:US
Practice Address - Phone:505-293-2881
Practice Address - Fax:888-506-2110
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-08816104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker