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General NPI Number Information
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NPI Number | 1871435313
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Entity Type | Individual
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Provider Name | CARLY MARIE BAMBRICK LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 12355 DE PAUL DR
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City | BRIDGETON
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State | MO
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Zip | 63044-2580
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Country | US
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Telephone | 314-344-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 23 JANIS ANN DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-1221
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Country | US
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Telephone | 314-344-7366
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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 | 2025021523
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License Number State | MO
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