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NPI Code Detail

MEDICARE: MR. MATTHEW JIRAUCH LCSW, CSACII

MEDICARE: MR. MATTHEW JIRAUCH LCSW, CSACII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1951MO
21041C0700XClinical Social Worker002227MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11951OTHERMOCERTIFIED SUBSTANCE ABUSE

General Provider Information

NPI Number : 1063531184
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW JIRAUCH LCSW, CSACII
Provider Business Mailing Address
First Line : 909 FEE FEE RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3801
Country : US
Telephone Number : 314-275-7600
Fax Number : 314-275-8486
Provider Business Practice Location Address
First Line : 909 FEE FEE RD
Second Line :
City : MARYLAND HEIGHTS
State : MO
Zip : 63043-3801
Country : US
Telephone Number : 314-275-7600
Fax Number : 314-275-8486
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 09/11/2025

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