Provider Demographics
NPI:1174543755
Name:MONTGOMERY, MOLLIE ANNIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:ANNIE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-1110
Mailing Address - Country:US
Mailing Address - Phone:413-665-3050
Mailing Address - Fax:
Practice Address - Street 1:239 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3269
Practice Address - Country:US
Practice Address - Phone:413-772-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health