Provider Demographics
NPI:1497156285
Name:SAN QUENTIN STATE PRISON
Entity Type:Organization
Organization Name:SAN QUENTIN STATE PRISON
Other - Org Name:SAN QUENTIN PRISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF MENTAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTHEI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:454-500-0415
Mailing Address - Street 1:59 ALMENAR DR
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1143
Mailing Address - Country:US
Mailing Address - Phone:454-500-0415
Mailing Address - Fax:
Practice Address - Street 1:59 ALMENAR DR
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1143
Practice Address - Country:US
Practice Address - Phone:454-500-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14440251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management