MEDICARE: MRS. PATRICIA F CROUGHAN MSW

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	593	MO

General Provider Information

NPI Number	:	1770758260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA F CROUGHAN MSW

Provider Business Mailing Address
First Line	:	130 S BEMISTON AVE
Second Line	:	SUITE 710
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1913
Country	:	US
Telephone Number	:	314-863-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 S BEMISTON AVE
Second Line	:	SUITE 710
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1913
Country	:	US
Telephone Number	:	314-863-1007
Fax Number	:

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

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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