Provider Demographics
NPI:1124446570
Name:MONTGOMERY, SABRENA (LCSW-C, LCSW)
Entity type:Individual
Prefix:
First Name:SABRENA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW-C, LCSW
Other - Prefix:
Other - First Name:SABRENA
Other - Middle Name:
Other - Last Name:BARNES-MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:15308 SHERWIN OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4061
Mailing Address - Country:US
Mailing Address - Phone:240-346-2289
Mailing Address - Fax:301-494-3234
Practice Address - Street 1:3261 OLD WASHINGTON RD STE 2020
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3231
Practice Address - Country:US
Practice Address - Phone:240-349-2507
Practice Address - Fax:301-494-3234
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17506104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD098540600Medicaid
MD480202100Medicaid