=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093439093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEN ELI FEUER LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2022
-----------------------------------------------------
Last Update Date | 10/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 S BRENTWOOD BLVD STE 205
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63144-1315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-773-9740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5023 LANSDOWNE AVE APT 1E
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63109-2415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-773-9740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2022010532
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------