Healthcare Provider Details

I. General information

NPI: 1336880848
Provider Name (Legal Business Name): CAROL ELISE NEWMARK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 WESTERNMILL DR
CHESTERFIELD MO
63017-2737
US

IV. Provider business mailing address

538 WESTERNMILL DR
CHESTERFIELD MO
63017-2737
US

V. Phone/Fax

Practice location:
  • Phone: 314-807-1596
  • Fax:
Mailing address:
  • Phone: 314-807-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000611
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number128131
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150101647
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: