Healthcare Provider Details

I. General information

NPI: 1285604710
Provider Name (Legal Business Name): TRACYNE MARIE CAUMARTIN MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 WASHINGTON AVE 9F
SAINT LOUIS MO
63103-1814
US

IV. Provider business mailing address

1531 WASHINGTON AVE 9F
SAINT LOUIS MO
63103-1814
US

V. Phone/Fax

Practice location:
  • Phone: 314-436-0313
  • Fax: 248-745-0396
Mailing address:
  • Phone: 314-436-0313
  • Fax: 248-745-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005025567
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: