Provider Demographics
NPI:1790756021
Name:MONTEGNA, DONNA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:MONTEGNA
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 1:3658 WAWONA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1704
Mailing Address - Country:US
Mailing Address - Phone:619-225-1465
Mailing Address - Fax:
Practice Address - Street 1:12845 POINTE DEL MAR WAY STE 200
Practice Address - Street 2:COASTAL PSYCHIATRIC MEDICAL ASSOCIATES
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3862
Practice Address - Country:US
Practice Address - Phone:858-259-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS127721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical