Healthcare Provider Details

I. General information

NPI: 1578824470
Provider Name (Legal Business Name): MISTY MCNAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY MCNAY-BEILMANN

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 EVANS LN
SAN JOSE CA
95125-2072
US

IV. Provider business mailing address

2090 EVANS LN
SAN JOSE CA
95125-2072
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-2414
  • Fax: 408-448-1815
Mailing address:
  • Phone: 408-793-2414
  • Fax: 408-448-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: