Healthcare Provider Details

I. General information

NPI: 1003482142
Provider Name (Legal Business Name): TERESA MARIA MCINERNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

IV. Provider business mailing address

335 E LAKE AVE
WATSONVILLE CA
95076-4826
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-1905
  • Fax:
Mailing address:
  • Phone: 831-728-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: