Provider Demographics
NPI:1346491180
Name:MCNAMARA, JAY THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:THOMAS
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:1735 MEDICAL ARTS BLDG.
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-333-3825
Mailing Address - Fax:612-333-6740
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:1735 MEDICAL ARTS BLDG.
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-333-3825
Practice Address - Fax:612-333-6740
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical