Mimose Montgomery, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW21589 Issued in FL

Practice address

3160 Powerline Rd
Oakland Park, FL 33309-5911

Phone

(305) 576-1234

NPI assigned

Dec 13, 2017

Last updated

Aug 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Care Resource Community Health Centers, IncGroup PAC ID 1658350749, shared by 6 NPIs, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mimose.montgomery.p1@direct.careresource.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Care Resource Community Health Centers, Inc

  dba Care resource

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
  • NPI 1053311373
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  TX

  Medicare reassignment NPD
• Therapeutic Resilience LLC

  • Clinical Social Worker
  • Miami Gardens, FL
  • NPI 1205520780
  Authorized official Same address or phone
• Care Resource Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Wilton Manors, FL
  • NPI 1093717464
  NPD
• Care Resource Community Health Centers, Inc.

  dba Care Resource Pharmacy Little Havana

  • Community/Retail Pharmacy
  • Miami, FL
  • NPI 1164039798
  NPD
• Care Resource Community Health Centers, Inc.

  • Community/Behavioral Health Agency
  • Oakland Park, FL
  • NPI 1720607377
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1922513860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8910 MIRAMAR PKWY STE 305B",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330254100",
            "telephone_number": "305-713-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3160 POWERLINE RD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333095911",
            "telephone_number": "305-576-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8910 Miramar Pkwy Ste 305B3160",
            "address_purpose": "LOCATION",
            "city": "Miramar",
            "state": "FL",
            "postal_code": "330254100",
            "country_code": "US",
            "telephone_number": "305-713-3261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MIMOSE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-13",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW21589",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW21589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Recovery & Wellness, LLC
• Joelle M Moliere, RPH, MPH, FAARM
• Adiela Molina, AP
• Tara Gaston Moncman, DO
• Stevengrower Gerald Monk, CASE MANAGEMENT
• William John Moran, D.C.
• Andrew Morgan, MS, CAP, RMHCI
• Jeffrey Demond Morgan, MD
• Angela Morris
• Moving With Tranquility LLC

• Clinical Social Worker in Oakland Park, FL
• Providers in Oakland Park, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.