Healthcare Provider Details

I. General information

NPI: 1285860627
Provider Name (Legal Business Name): SUSAN O WARSHAW M.S.W., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 CLAYTON ROAD SUITE 204
ST. LOUIS MO
63117
US

IV. Provider business mailing address

7750 CLAYTON ROAD SUITE 204
ST. LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-646-7064
  • Fax:
Mailing address:
  • Phone: 314-646-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000256
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number300076
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: