MEDICARE: FRIENDS OF AFRICAN AMER. FAMILY SERVICE CENTER

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104100000X	OTHER	MO	SOCIAL WORKER
2	1O41CO700X	OTHER	MO	SOCIAL WORKER CLINICAL

General Provider Information

NPI Number	:	1386989127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS OF AFRICAN AMER. FAMILY SERVICE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 52355
Second Line	:	1033 WHITTIER AVE. ROOM 118
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-8355
Country	:	US
Telephone Number	:	314-867-6470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 WHITTIER AVENUE
Second Line	:	ROOM 118
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113
Country	:	US
Telephone Number	:	314-867-6470
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. BARBARA JEAN ROBINSON
Credential	:	MSW/LCSW
Telephone Number	:	314-867-6470

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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