Provider Demographics
NPI:1316152325
Name:MONTAGUE-JOSEPH, DAWN (LCSW-C)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MONTAGUE-JOSEPH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10014 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1154
Mailing Address - Country:US
Mailing Address - Phone:410-608-8158
Mailing Address - Fax:410-560-6136
Practice Address - Street 1:9475 DEERECO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2118
Practice Address - Country:US
Practice Address - Phone:410-560-6135
Practice Address - Fax:410-560-6136
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD651204Medicaid