MEDICARE: MRS. BRIANNE ELIZABETH SERDAR MSW, 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	2009007769	MO

General Provider Information

NPI Number	:	1639477177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIANNE ELIZABETH SERDAR MSW, LCSW

Provider Business Mailing Address
First Line	:	1600 S BIG BEND BLVD FL 2
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-477-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S BIG BEND BLVD FL 2
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-477-7533
Fax Number	:

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

Provider Enumeration Date	:	03/08/2011
Last Update Date	:	01/14/2022

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