1083533590 NPI number — MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.

Table of content: (NPI 1083533590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083533590 NPI number — MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1083533590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
574 CORTES ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-3242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-747-4254
Provider Business Mailing Address Fax Number:
831-373-3821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 DEVINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95110-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-217-0880
Provider Business Practice Location Address Fax Number:
408-831-9441
Provider Enumeration Date:
07/10/2026

Additional Information

Authorized Official

Authorized Official Last Name:
PURI
Authorized Official First Name:
MARY
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
208-250-2724

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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