1316152325 NPI number — DAWN MONTAGUE-JOSEPH LCSW-C

Table of content: DAWN MONTAGUE-JOSEPH LCSW-C (NPI 1316152325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316152325 NPI number — DAWN MONTAGUE-JOSEPH LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTAGUE-JOSEPH
Provider First Name:
DAWN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316152325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10014 VILLAGE GREEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21163-1154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-608-8158
Provider Business Mailing Address Fax Number:
410-560-6136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9475 DEERECO RD
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-560-6135
Provider Business Practice Location Address Fax Number:
410-560-6136
Provider Enumeration Date:
05/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12239 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 651204 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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