Provider Demographics
NPI:1669552493
Name:MONTGOMERY, PATRICIA SHIUY (LCSW RN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SHIUY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW RN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:SHIUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 UNION AVENUE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3949
Mailing Address - Country:US
Mailing Address - Phone:901-726-1284
Mailing Address - Fax:901-726-4396
Practice Address - Street 1:1835 UNION AVENUE
Practice Address - Street 2:SUITE 315
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3949
Practice Address - Country:US
Practice Address - Phone:901-726-1284
Practice Address - Fax:901-726-4396
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4113104100000X
TN129874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441267Medicaid