Provider Demographics
NPI:1356174809
Name:CHRISTIE MONTGOMERY THERAPY LLC
Entity type:Organization
Organization Name:CHRISTIE MONTGOMERY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-486-4628
Mailing Address - Street 1:12 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1628
Mailing Address - Country:US
Mailing Address - Phone:505-486-4628
Mailing Address - Fax:
Practice Address - Street 1:12 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1628
Practice Address - Country:US
Practice Address - Phone:505-486-4628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty