Healthcare Provider Details

I. General information

NPI: 1831502830
Provider Name (Legal Business Name): MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 CORTES ST.
MONTEREY CA
93940-1462
US

IV. Provider business mailing address

574 CORTES ST
MONTEREY CA
93940-3242
US

V. Phone/Fax

Practice location:
  • Phone: 831-747-4254
  • Fax: 831-373-3821
Mailing address:
  • Phone: 831-747-1727
  • Fax: 831-373-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH PURI
Title or Position: DIRECTOR OF OPERATIONS
Credential: LPCC
Phone: 208-250-2724