MEDICARE: JEREMY HODESS LCSW

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	2002014228	MO
2	1041C0700X	Clinical Social Worker	SW25547	FL
3	1041C0700X	Clinical Social Worker	LICSW126602	MA
4	1041C0700X	Clinical Social Worker	CSW.09928083	CO

General Provider Information

NPI Number	:	1891142311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY HODESS LCSW

Provider Business Mailing Address
First Line	:	414 COUNTRY OAK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2822
Country	:	US
Telephone Number	:	314-201-5358
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 COUNTRY OAK DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-2822
Country	:	US
Telephone Number	:	314-974-5524
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/21/2026

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