Provider Demographics
NPI:1841441797
Name:MONTGOMERY, KAZUKO TAKEUCHI (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAZUKO
Middle Name:TAKEUCHI
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KAZUKO
Other - Middle Name:
Other - Last Name:TAKEUCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:875 MASSACHUSETTS AVENUE SUITE 43
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-354-4450
Mailing Address - Fax:
Practice Address - Street 1:1 ARNOLD CIR STE 8
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2250
Practice Address - Country:US
Practice Address - Phone:617-932-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9166103TC0700X
VT048.0060666103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical