MEDICARE: ALEXANDRA CECILIA WHITE VISER 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	2017003782	MO

General Provider Information

NPI Number	:	1710486154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA CECILIA WHITE VISER LCSW

Provider Business Mailing Address
First Line	:	18 N IOLA DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 ARSENAL ST STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2503
Country	:	US
Telephone Number	:	314-252-0174
Fax Number	:

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

Provider Enumeration Date	:	02/11/2018
Last Update Date	:	02/11/2018

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