Healthcare Provider Details

I. General information

NPI: 1467384602
Provider Name (Legal Business Name): NAOMI ELIANA RAZNICK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625A MCCAUSLAND AVE
SAINT LOUIS MO
63109-1126
US

IV. Provider business mailing address

3625A MCCAUSLAND AVE
SAINT LOUIS MO
63109-1126
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-0509
  • Fax:
Mailing address:
  • Phone: 314-954-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025049731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: