Provider Demographics
NPI:1801954607
Name:MONTGOMERY, SHARON RYAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RYAN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COMMUNITY PL
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7500
Mailing Address - Country:US
Mailing Address - Phone:973-285-0579
Mailing Address - Fax:973-539-3687
Practice Address - Street 1:20 COMMUNITY PL
Practice Address - Street 2:4TH FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7500
Practice Address - Country:US
Practice Address - Phone:973-285-0579
Practice Address - Fax:973-539-3687
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100193100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ563200Medicare ID - Type Unspecified