Healthcare Provider Details

I. General information

NPI: 1326287772
Provider Name (Legal Business Name): JOEL F ACHTENBERG MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MARION AVE
WEBSTER GROVES MO
63119-2617
US

IV. Provider business mailing address

322 MARION AVE
WEBSTER GROVES MO
63119-2617
US

V. Phone/Fax

Practice location:
  • Phone: 314-550-2766
  • Fax:
Mailing address:
  • Phone: 314-550-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2001004080
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: