Provider Demographics
NPI:1780403592
Name:MONTGOMERY, KIMBERLEY DAWN (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:DAWN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4248
Mailing Address - Country:US
Mailing Address - Phone:202-355-3709
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE STE 110
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4248
Practice Address - Country:US
Practice Address - Phone:202-355-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD304521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical