Healthcare Provider Details

I. General information

NPI: 1982886933
Provider Name (Legal Business Name): MONICA MONEE MATTHIEU LCSW, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

1 BROOKINGS DR CAMPUS BOX 1196
SAINT LOUIS MO
63130-4862
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone: 314-935-7516
  • Fax: 314-935-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4207
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: