Provider Demographics
NPI:1194849414
Name:MCNAMARA, SHARON ANNE STEIN (EDD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANNE STEIN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:ANNE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:5563 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-9126
Mailing Address - Country:US
Mailing Address - Phone:651-698-1799
Mailing Address - Fax:651-481-3209
Practice Address - Street 1:4700 LEXINGTON AVE N STE B1A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-5867
Practice Address - Country:US
Practice Address - Phone:651-698-1799
Practice Address - Fax:651-481-3209
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2991103TF0200X, 103T00000X, 103TA0400X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-54388OtherMEDICA
MN789815100Medicaid
MN105050OtherUCARE
MN4H678STOtherBLUE CROSS
MN789815100Medicaid