Provider Demographics
NPI:1831877844
Name:MONTGOMERY, JAHNA DIANNE
Entity type:Individual
Prefix:
First Name:JAHNA
Middle Name:DIANNE
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 1:255 CEDAR HILL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-0175
Mailing Address - Country:US
Mailing Address - Phone:800-465-3203
Mailing Address - Fax:
Practice Address - Street 1:255 CEDAR HILL
Practice Address - Street 2:SUITE 200
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:800-465-3203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician