MEDICARE: CORNERSTONE THERAPY SERVICES

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	305S00000X	Point of Service	2015043579	MO

General Provider Information

NPI Number	:	1790136216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	7905 BIG BEND BLVD STE 206
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2715
Country	:	US
Telephone Number	:	314-596-2049
Fax Number	:

Provider Business Practice Location Address
First Line	:	7905 BIG BEND BLVD STE 206
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2715
Country	:	US
Telephone Number	:	314-596-2049
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. LAURA FONSECA
Credential	:	LCSW
Telephone Number	:	314-596-2049

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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Directions to “CORNERSTONE THERAPY SERVICES ” Practice Location

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