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General NPI Number Information
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NPI Number | 1083533590
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Entity Type | Organization
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Legal Business Name | MONTEREY INSTITUTE LICENSED CLINICAL SOCIAL WORKER, INC.
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 79 DEVINE ST
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City | SAN JOSE
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State | CA
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Zip | 95110-2483
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Country | US
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Telephone | 408-217-0880
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Fax | 408-831-9441
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Provider Business Mailing Address
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Address Line | 574 CORTES ST
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City | MONTEREY
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State | CA
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Zip | 93940-3242
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Country | US
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Telephone | 831-747-4254
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Fax | 831-373-3821
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MARY BETH PURI
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Credential | LPCC
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Telephone | 208-250-2724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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