Individual
MS. MARY ELIZABETH MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
95 INDIA ST, PORTLAND, ME 04101-4250
(207) 939-1927
Mailing address
44 FIELDSTONE DR, YARMOUTH, ME 04096-8336
(207) 939-1927
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099170
ANTHEM PROVIDER NUMBER
ME
Enumeration date
06/13/2007
Last updated
07/08/2007
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