Healthcare Provider Details

I. General information

NPI: 1710766936
Provider Name (Legal Business Name): SAMANTHA FERRARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N CLAY AVE STE 215
KIRKWOOD MO
63122-4068
US

IV. Provider business mailing address

7110 OAKLAND AVE STE 211
RICHMOND HEIGHTS MO
63117-1868
US

V. Phone/Fax

Practice location:
  • Phone: 314-740-2251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023044023
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number202103438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: