Healthcare Provider Details

I. General information

NPI: 1194114694
Provider Name (Legal Business Name): LAURA MAHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W. LOCKWOOD AVE SUITE 201
ST. LOUIS MO
63119
US

IV. Provider business mailing address

9021 LOWILL LN
SAINT LOUIS MO
63126-2912
US

V. Phone/Fax

Practice location:
  • Phone: 314-941-0851
  • Fax: 314-968-1901
Mailing address:
  • Phone: 314-941-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2013038385
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: