| NPI | 1790136216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA FONSECA Licensed Clinical Social Worker 314-596-2049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 2015043579) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |