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NPI Code Detail

MEDICARE: ELIZABETH CRUZAN MSW, LMSW

MEDICARE:   ELIZABETH  CRUZAN  MSW, LMSW
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
1104100000XSocial Worker2014024202MO

General Provider Information

NPI Number : 1295150415
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CRUZAN MSW, LMSW
Provider Business Mailing Address
First Line : 8315 S BROADWAY
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63111-3804
Country : US
Telephone Number : 314-631-4299
Fax Number : 314-631-4316
Provider Business Practice Location Address
First Line : 8315 S BROADWAY
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63111-3804
Country : US
Telephone Number : 314-631-4299
Fax Number : 314-631-4316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2014
Last Update Date : 02/04/2015

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Directions to “ ELIZABETH CRUZAN MSW, LMSW” Practice Location

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