Provider Demographics
NPI:1336647775
Name:KING, MARYCARMEL (MSW)
Entity Type:Individual
Prefix:
First Name:MARYCARMEL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARYCARMEL
Other - Middle Name:
Other - Last Name:MCEWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2220 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2613
Mailing Address - Country:US
Mailing Address - Phone:408-885-5759
Mailing Address - Fax:
Practice Address - Street 1:2220 MOORPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2613
Practice Address - Country:US
Practice Address - Phone:408-885-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker