Provider Demographics
NPI:1346899200
Name:MCBRIDE, MARY MICHELLE (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MICHELLE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SAINT LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1447
Mailing Address - Country:US
Mailing Address - Phone:636-484-0310
Mailing Address - Fax:
Practice Address - Street 1:5988 MID RIVERS MALL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-7119
Practice Address - Country:US
Practice Address - Phone:636-362-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180353251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty