Healthcare Provider Details

I. General information

NPI: 1306147368
Provider Name (Legal Business Name): REBECCA MERCURIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8084 WATSON RD SUITE 243
WEBSTER GROVES MO
63119-5326
US

IV. Provider business mailing address

8084 WATSON RD
WEBSTER GROVES MO
63119-5326
US

V. Phone/Fax

Practice location:
  • Phone: 314-302-0396
  • Fax:
Mailing address:
  • Phone: 314-302-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2010038266
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014369
License Number StateIL

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: