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General NPI Number Information
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NPI Number | 1649689837
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Entity Type | Individual
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Provider Name | ANDREW ZEMCUZNIKOV LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/13/2014
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 11457 OLDE CABIN RD STE 345
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City | CREVE COEUR
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State | MO
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Zip | 63141
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Country | US
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Telephone | 314-537-5035
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Fax | 636-517-1176
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Provider Business Mailing Address
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Address Line | 724 SPRING HILL FARM DR
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City | BALLWIN
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State | MO
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Zip | 63021-8419
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Country | US
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Telephone | 636-225-3373
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Fax | 636-517-1176
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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 | 000129
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License Number State | MO
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