Provider Demographics
NPI:1649896523
Name:MOLLIE MONTGOMERY, LCSW
Entity type:Organization
Organization Name:MOLLIE MONTGOMERY, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-418-2462
Mailing Address - Street 1:341 EASTERN PKWY APT 5J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4860
Mailing Address - Country:US
Mailing Address - Phone:561-418-2462
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1501
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1115
Practice Address - Country:US
Practice Address - Phone:347-927-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty