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General NPI Number Information
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NPI Number | 1235676719
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Entity Type | Individual
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Provider Name | CONSTANCE LEE RICHARDS MSW, ACSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 655 CRAIG RD SUITE 160
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City | CREVE COEUR
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State | MO
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Zip | 63141-7132
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Country | US
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Telephone | 314-732-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 4323 LACLEDE AVE APT B
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2251
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Country | US
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Telephone | 314-732-3217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 002043
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License Number State | MO
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