Active NPI
Carol S Montgomery, MFT
- Marriage & Family Therapist
- San Dimas, CA
National Provider Identifier
1992914873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC35018
- Practice address
- 448 E Foothill Blvd
Suite 101
San Dimas, CA 91773-1205 - Phone
- (909) 592-2090
- Fax
- (909) 592-4149
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC35018 | CA | Primary |
Addresses
Primary practice location
448 E Foothill Blvd
Suite 101
San Dimas, CA 91773-1205
Mailing address
PO Box 4124
San Dimas, CA 91773-8124
Phone (909) 592-2090
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC35018 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262736000000",
"number": "1992914873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4124",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917738124",
"telephone_number": "909-592-2090",
"fax_number": "909-592-4149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "448 E FOOTHILL BLVD",
"address_2": "SUITE 101",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917731205",
"telephone_number": "909-592-2090",
"fax_number": "909-592-4149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "CAROL",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2010-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC35018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Dimas, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.