Doctor Name: | MRS. LYNETTE SUZANNE MONTGOMERY |
NPI Number: | 1225401144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CASAC |
License Number: | 29787 |
Business Practice Address: | 380 Freeville Rd Freeville, NY - 130689684 |
Business Phone Number: | 6078446493 |
Business Fax Number: | |
Mailing Address: | 15 Halstead Rd, CORTLAND |
State: | NY |
Postal Code: | 130453405 |
Phone Number: | 6073450255 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2015 |
NPI Last Update Date: | 11/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 29787 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |