Healthcare Provider Details

I. General information

NPI: 1487860417
Provider Name (Legal Business Name): CHERYL GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 LADUE RD THIRD FLOOR, STE.317
SAINT LOUIS MO
63124-2079
US

IV. Provider business mailing address

8820 LADUE ROAD THIRD FLOOR STE 317
SAINT LOUIS MO
63124
US

V. Phone/Fax

Practice location:
  • Phone: 314-754-3258
  • Fax:
Mailing address:
  • Phone: 314-754-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberSW004527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: