Healthcare Provider Details

I. General information

NPI: 1770722969
Provider Name (Legal Business Name): MAUREEN M LENZ LCSW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MILL ST
FESTUS MO
63028-1815
US

IV. Provider business mailing address

PO BOX 682
FESTUS MO
63028-0682
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-2292
  • Fax:
Mailing address:
  • Phone: 636-933-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005559
License Number StateMO

VIII. Authorized Official

Name: MAUREEN LENZ
Title or Position: OWNER
Credential: LCSW
Phone: 636-933-2292