Healthcare Provider Details

I. General information

NPI: 1750443776
Provider Name (Legal Business Name): SHARON VENTRESS MARBARGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 CLAYTON ROAD SUITE 207
ST LOUIS MO
63117
US

IV. Provider business mailing address

7750 CLAYTON ROAD SUITE 207
ST LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-2620
  • Fax: 314-781-4505
Mailing address:
  • Phone: 314-781-2620
  • Fax: 314-781-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004677
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier114159
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBLUE CROSS
# 2
IdentifierS11857
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMERCY HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: