Healthcare Provider Details

I. General information

NPI: 1386782514
Provider Name (Legal Business Name): ANNE MARIE LYNCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE MARIE POTCHEN LCSW

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

15 N HARTNETT AVE
FERGUSON MO
63135-2136
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-4959
  • Fax: 314-525-1886
Mailing address:
  • Phone: 314-524-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004019129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: