Provider Demographics
NPI:1720112899
Name:MONTGOMERY, JOANNE CS (LCSW, RMT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:CS
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LCSW, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 CLOUDCROFT DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5631
Mailing Address - Country:US
Mailing Address - Phone:310-459-1006
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT STE 201
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7427
Practice Address - Country:US
Practice Address - Phone:805-241-7473
Practice Address - Fax:805-777-3574
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS177571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical