Provider Demographics
NPI:1588004683
Name:MCNAMARA, KELLY KATHLEEN (OTS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KATHLEEN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:OTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 POTRERO ST STE 42-103
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2779
Mailing Address - Country:US
Mailing Address - Phone:831-466-9307
Mailing Address - Fax:831-466-9748
Practice Address - Street 1:303 POTRERO ST STE 42-103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2779
Practice Address - Country:US
Practice Address - Phone:831-466-9307
Practice Address - Fax:831-466-9748
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health