Healthcare Provider Details

I. General information

NPI: 1023761343
Provider Name (Legal Business Name): MOLLIE PATRICE APPELBAUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 FERN RIDGE PKWY STE 110
SAINT LOUIS MO
63141-4405
US

IV. Provider business mailing address

1294 GOLDEN GATE LN
SAINT PETERS MO
63376-5231
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-8599
  • Fax:
Mailing address:
  • Phone: 314-625-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2021023368
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: