Provider Demographics
NPI:1831502830
Name:MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:SCD
Authorized Official - Phone:314-378-6832
Mailing Address - Street 1:574 CORTES ST.
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:831-747-4254
Mailing Address - Fax:831-373-3821
Practice Address - Street 1:574 CORTES ST.
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:831-747-4254
Practice Address - Fax:831-373-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty