Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | LP2991 | MN |
Y | 103T00000X | Psychologist | LP2991 | MN |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | LP2991 | MN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | LP2991 | MN |
N | 103TF0200X | Forensic Psychologist | LP2991 | MN |
NPI | 1194849414 |
---|---|
Provider Name | Dr. Sharon Anne Stein Mcnamara |
First Address | Shoreview, MN 55126-9126 |
Second Address | Saint Paul, MN 55126-5867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 24/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105050 | UCARE (01) | MN |
4H678ST | BLUE CROSS (01) | MN |
61-54388 | MEDICA (01) | MN |
68-000-1249 | (02) | MN |
789815100 | (05) | MN |