Healthcare Provider Details

I. General information

NPI: 1396991576
Provider Name (Legal Business Name): MARIA L. MISKOVIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS MARIA LANA PERFETTO

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12882 MANCHESTER ROAD SUITE 201
ST. LOUIS MO
63131
US

IV. Provider business mailing address

12882 MANCHESTER ROAD SUITE 201
ST. LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 314-863-9912
  • Fax: 314-863-9918
Mailing address:
  • Phone: 314-863-9912
  • Fax: 314-863-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005018313
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: