Provider Demographics
NPI:1124626254
Name:MONTGOMERY, ROSE D (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:D
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ATWATER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8782
Mailing Address - Country:US
Mailing Address - Phone:610-646-1851
Mailing Address - Fax:484-355-5181
Practice Address - Street 1:1200 ATWATER DR STE 130
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8782
Practice Address - Country:US
Practice Address - Phone:610-646-1851
Practice Address - Fax:484-355-5181
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0240431041C0700X
PASW137660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical