Organization
NEW LEAF FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARYBETH GRAS LCSW (LICENSED CLINICAL SOCIAL WORKER)
(314) 629-9862
Entity
Organization
Contact information
Practice address
4625 LINDELL BLVD, SUITE 315, SAINT LOUIS, MO 63108-3729
(314) 629-9862
Mailing address
4200 SHENANDOAH AVE, SAINT LOUIS, MO 63110-3513
(314) 629-9862
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2001022248
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176889
BLUE CROSS BLUE SHIELD
MO
Enumeration date
01/05/2006
Last updated
08/22/2020
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