Healthcare Provider Details

I. General information

NPI: 1205932878
Provider Name (Legal Business Name): SHIRLEY JEAN CAGGIANO LCSW/PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10626 HIGHWAY 21
HILLSBORO MO
63050-5039
US

IV. Provider business mailing address

2561 WEYMOUTH DR
HIGH RIDGE MO
63049-2417
US

V. Phone/Fax

Practice location:
  • Phone: 636-789-2747
  • Fax: 636-789-5815
Mailing address:
  • Phone: 656-376-8894
  • Fax: 636-789-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000734
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: