Healthcare Provider Details

I. General information

NPI: 1285145367
Provider Name (Legal Business Name): EMILY PRICE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

IV. Provider business mailing address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-2700
  • Fax: 314-268-4028
Mailing address:
  • Phone: 314-268-2700
  • Fax: 314-268-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2016033432
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.022466
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2019044559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: