Provider Demographics
NPI:1811085806
Name:MONTGOMERY, MYLES BRADLEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:MYLES
Middle Name:BRADLEY
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 CALIFORNIA AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7155
Mailing Address - Country:US
Mailing Address - Phone:916-833-4394
Mailing Address - Fax:
Practice Address - Street 1:7940 CALIFORNIA AVE STE 11
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7155
Practice Address - Country:US
Practice Address - Phone:916-422-2301
Practice Address - Fax:916-422-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical