Healthcare Provider Details

I. General information

NPI: 1952884397
Provider Name (Legal Business Name): MARNI A DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7751 CARONDELET AVE STE 600B
SAINT LOUIS MO
63105-4043
US

IV. Provider business mailing address

7751 CARONDELET AVE STE 600B
SAINT LOUIS MO
63105-4043
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-7071
  • Fax:
Mailing address:
  • Phone: 314-479-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2016013409
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: