MEDICARE: MS. CARLY MARIE BAMBRICK LMSW

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	2025021523	MO

General Provider Information

NPI Number	:	1871435313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLY MARIE BAMBRICK LMSW

Provider Business Mailing Address
First Line	:	23 JANIS ANN DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1221
Country	:	US
Telephone Number	:	314-344-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	12355 DE PAUL DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2580
Country	:	US
Telephone Number	:	314-344-7101
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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