Healthcare Provider Details

I. General information

NPI: 1033351333
Provider Name (Legal Business Name): RUTH SUSAN ROSENSTEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD SUITE 600
SAINT LOUIS MO
63141-6393
US

IV. Provider business mailing address

12647 OLIVE BOULEVARD SUITE 600
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 180-032-5398
  • Fax:
Mailing address:
  • Phone: 180-032-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLCSW-3888
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: