Individual
DR. MARY M CRADOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1 CHILDRENS PL, #3N14, SAINT LOUIS, MO 63110-1002
(314) 454-6069
(314) 454-4013
Mailing address
1 CHILDRENS PL, #3N14, SAINT LOUIS, MO 63110-1002
(314) 454-6069
(314) 454-4013
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2001030205
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106592
UBH
—
01
—
160276
BCBS
—
05
—
495448706
—
MO
Enumeration date
07/20/2006
Last updated
11/02/2021
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