Provider Demographics
NPI:1770021156
Name:MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:HARMONY PLACE MONTEREY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-250-6507
Mailing Address - Street 1:398 FOAM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1462
Mailing Address - Country:US
Mailing Address - Phone:831-747-1727
Mailing Address - Fax:
Practice Address - Street 1:398 FOAM ST STE 200
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1462
Practice Address - Country:US
Practice Address - Phone:831-747-1727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty