Provider Demographics
NPI:1497579965
Name:MONTGOMERY, BRIGITTE PARKS
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:PARKS
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1982 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2360
Mailing Address - Country:US
Mailing Address - Phone:513-544-9597
Mailing Address - Fax:
Practice Address - Street 1:1982 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2360
Practice Address - Country:US
Practice Address - Phone:513-544-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool