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NPI Code Detail

MEDICARE: NEORITHA HUMPHREY LCSW

MEDICARE:   NEORITHA  HUMPHREY  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
11041C0700XClinical Social WorkerSW003455MO
21041C0700XClinical Social Worker1041C0700XMO

General Provider Information

NPI Number : 1780872317
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEORITHA HUMPHREY LCSW
Provider Business Mailing Address
First Line : 1739 CAROLYN PARK DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63130-1033
Country : US
Telephone Number : 314-482-8278
Fax Number : 314-428-7670
Provider Business Practice Location Address
First Line : 1739 CAROLYN PARK DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63130-1033
Country : US
Telephone Number : 314-428-8278
Fax Number : 314-428-7670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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Directions to “ NEORITHA HUMPHREY LCSW” Practice Location

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