MEDICARE: CAROLINE PENBERTHY M.S.W., L.C.S.W.

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	SW000802	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	472758	OTHER	MO	HEALTHLINK
2	R01055	OTHER	MO	MERCY HEALTH PLANS
3	6236004	OTHER	MO	UNITED BEHAVIORAL HEALTH
4	125668	OTHER	MO	BLUE CROSS BLUE SHIELD
5	O62230	OTHER	MO	EXCLUSIVE CHOICE

General Provider Information

NPI Number	:	1639160062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE PENBERTHY M.S.W., L.C.S.W.

Provider Business Mailing Address
First Line	:	12166 OLD BIG BEND RD
Second Line	:	SUITE 100
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6844
Country	:	US
Telephone Number	:	314-909-0211
Fax Number	:	314-909-0323

Provider Business Practice Location Address
First Line	:	12166 OLD BIG BEND RD
Second Line	:	SUITE 100
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6844
Country	:	US
Telephone Number	:	314-909-0211
Fax Number	:	314-909-0323

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/09/2007

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