Provider Demographics
NPI:1487261996
Name:WOOD-MONTGOMERY, KIBIBI LATEEF (CSW)
Entity type:Individual
Prefix:
First Name:KIBIBI
Middle Name:LATEEF
Last Name:WOOD-MONTGOMERY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 SPORTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6151
Mailing Address - Country:US
Mailing Address - Phone:502-500-3327
Mailing Address - Fax:
Practice Address - Street 1:2820 GRANT LINE RD # 10
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2494
Practice Address - Country:US
Practice Address - Phone:812-981-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker