Healthcare Provider Details

I. General information

NPI: 1417134818
Provider Name (Legal Business Name): MELISSA T SCOLARO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 LADUE RD. STE. 306
ST. LOUIS MO
63124
US

IV. Provider business mailing address

8820 LADUE RD. STE. 306
ST. LOUIS MO
63124
US

V. Phone/Fax

Practice location:
  • Phone: 314-561-3191
  • Fax:
Mailing address:
  • Phone: 314-561-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2006005853
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: