MEDICARE: MS. CYNTHIA MARIE LIVELY LCSW

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	003758	MO

General Provider Information

NPI Number	:	1366644833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA MARIE LIVELY LCSW

Provider Business Mailing Address
First Line	:	706 LOCUST ST
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-2022
Country	:	US
Telephone Number	:	314-808-0489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 N WARSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1807
Country	:	US
Telephone Number	:	314-989-9727
Fax Number	:	314-989-9799

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	07/08/2007

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