Provider Demographics
NPI:1841388238
Name:MONTAGUE, NAOMI D (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:D
Last Name:MONTAGUE
Suffix:
Gender:
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 ELMWOOD AVE STE 299
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2213
Mailing Address - Country:US
Mailing Address - Phone:585-419-7019
Mailing Address - Fax:585-627-0792
Practice Address - Street 1:6539 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1441
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:585-398-7376
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047370-011041C0700X
NYR0473701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical