MEDICARE: MR. RAYMOND THOMAS FEZZI MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	000775	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063502920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND THOMAS FEZZI MSW

Provider Business Mailing Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:	314-894-9696
Fax Number	:	314-894-2942

Provider Business Practice Location Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:	314-894-9696
Fax Number	:	314-894-2942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2016

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