Healthcare Provider Details

I. General information

NPI: 1902902638
Provider Name (Legal Business Name): SHARON STEIN MCNAMARA ED D PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LEXINGTON AVE N STE B1A
SHOREVIEW MN
55126-5867
US

IV. Provider business mailing address

5563 PARK PLACE DR
SHOREVIEW MN
55126-9126
US

V. Phone/Fax

Practice location:
  • Phone: 651-698-1799
  • Fax: 651-481-3209
Mailing address:
  • Phone: 651-698-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberMN LP2991
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberMN LP2991
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberMN LP2991
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2991
License Number StateMN

VIII. Authorized Official

Name: DR. SHARON STEIN MCNAMARA
Title or Position: LICENSED PSYCHOLOGIST
Credential: L.P.
Phone: 651-698-0038