Provider Demographics
NPI:1770668097
Name:AMY D. MONTAGUE, PH.D.
Entity Type:Organization
Organization Name:AMY D. MONTAGUE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-497-7047
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:SUITE # 100E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6015
Mailing Address - Country:US
Mailing Address - Phone:310-497-7047
Mailing Address - Fax:310-316-9032
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:SUITE #100E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6015
Practice Address - Country:US
Practice Address - Phone:310-497-7047
Practice Address - Fax:310-316-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ09780Medicare UPIN