MEDICARE: MS. VICKI BUDD-DARBY 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	MOSW005387	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6290563	OTHER	MO	UNITED HEALTH CARE
2	119695	OTHER	MO	BLUE CROSS BLUE SHILED

General Provider Information

NPI Number	:	1154450088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI BUDD-DARBY MSW

Provider Business Mailing Address
First Line	:	3008 RIDGEVIEW DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4543
Country	:	US
Telephone Number	:	314-510-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	6403 CLAYTON RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1810
Country	:	US
Telephone Number	:	314-495-1096
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	02/09/2012

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