Provider Demographics
NPI:1396545372
Name:MONTGOMERY, KEVIN D (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W CAMPLAIN RD
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1657
Mailing Address - Country:US
Mailing Address - Phone:732-543-4045
Mailing Address - Fax:
Practice Address - Street 1:1915 W CAMPLAIN RD
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1657
Practice Address - Country:US
Practice Address - Phone:732-543-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL071044001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical