Provider Demographics
NPI:1760674972
Name:MONTAGNA, NANCY K (PH D)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:MONTAGNA
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 FIDLER LN
Mailing Address - Street 2:#1417
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3425
Mailing Address - Country:US
Mailing Address - Phone:301-587-5735
Mailing Address - Fax:
Practice Address - Street 1:1110 FIDLER LN
Practice Address - Street 2:#1417
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3425
Practice Address - Country:US
Practice Address - Phone:301-587-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD993103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TH0004X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy