Individual
MARY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 N TUCKER BLVD, SAINT LOUIS, MO 63101-1931
(314) 814-8628
(314) 814-8542
Mailing address
1717 BIDDLE ST, SAINT LOUIS, MO 63106-3454
(314) 814-8628
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2003026224
MO
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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