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General NPI Number Information
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NPI Number | 1891896403
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Entity Type | Individual
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Provider Name | MARY P WEGERSKI LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 314-652-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 PINELLAS BAYWAY S 401
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City | ST PETERSBURG
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State | FL
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Zip | 33715-2169
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Country | US
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Telephone | 727-667-7281
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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 | 037568
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License Number State | NY
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