Healthcare Provider Details

I. General information

NPI: 1982108163
Provider Name (Legal Business Name): ANDREW ROBERTS REILLY MENATTI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW BALLAS RD STE 201
CREVE COEUR MO
63141-6819
US

IV. Provider business mailing address

522 N NEW BALLAS RD STE 201
CREVE COEUR MO
63141-6819
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-4210
  • Fax: 314-833-4212
Mailing address:
  • Phone: 314-833-4210
  • Fax: 314-833-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number2017002021
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2017002021
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2017002021
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2017002021
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: