Provider Demographics
NPI:1154525913
Name:MONTAGUE, ROBERT SANFORD (LCSW, MS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SANFORD
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:LCSW, MS
Other - Prefix:MR
Other - First Name:ROMAN
Other - Middle Name:SANFORD
Other - Last Name:MONTAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, MS
Mailing Address - Street 1:6030 TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4712
Mailing Address - Country:US
Mailing Address - Phone:916-630-9188
Mailing Address - Fax:916-485-1569
Practice Address - Street 1:6030 TURQUOISE DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4712
Practice Address - Country:US
Practice Address - Phone:916-630-9188
Practice Address - Fax:916-485-1569
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 165501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical