MEDICARE: MS. PHOEBE SUE PINKERTON LCSW MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	001308	MO

General Provider Information

NPI Number	:	1003049099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHOEBE SUE PINKERTON LCSW MSW

Provider Business Mailing Address
First Line	:	PO BOX 735
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63032-0735
Country	:	US
Telephone Number	:	314-477-3165
Fax Number	:	314-921-9834

Provider Business Practice Location Address
First Line	:	3820 N 14TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2928
Country	:	US
Telephone Number	:	314-477-3165
Fax Number	:	314-921-9834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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