Healthcare Provider Details

I. General information

NPI: 1477470656
Provider Name (Legal Business Name): LISA JANE MARIE LUKIES ROBERTS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRESTWOOD EXECUTIVE CTR STE 324
SAINT LOUIS MO
63126-1900
US

IV. Provider business mailing address

50 CRESTWOOD EXECUTIVE CTR STE 324
SAINT LOUIS MO
63126-1900
US

V. Phone/Fax

Practice location:
  • Phone: 314-339-3163
  • Fax:
Mailing address:
  • Phone: 314-339-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2026021806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: