=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871475277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYA WASSERSTROM LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 S WOODS MILL RD STE 150
-----------------------------------------------------
City | TOWN AND COUNTRY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-9528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-939-2550
-----------------------------------------------------
Fax | 314-627-4978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 N SCOTTSDALE RD STE 2500
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-7630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2025033959
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------