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General NPI Number Information
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NPI Number | 1831059187
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Entity Type | Individual
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Provider Name | MARISEL GAVIRIA ROBERTSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 401 HOLLY HILLS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63111-2410
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Country | US
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Telephone | 314-353-5190
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Fax | 314-353-7631
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Provider Business Mailing Address
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Address Line | 3004 TEXAS AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1530
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Country | US
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Telephone | 310-221-1160
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2023041227
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License Number State | MO
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