Healthcare Provider Details

I. General information

NPI: 1366425928
Provider Name (Legal Business Name): ROBYN SUE CHERRY MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 CONWAY VILLAGE DR
SAINT LOUIS MO
63141-5807
US

IV. Provider business mailing address

532 CONWAY VILLAGE DR
SAINT LOUIS MO
63141-5807
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-0700
  • Fax:
Mailing address:
  • Phone: 143-991-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: