Provider Demographics
NPI:1487818498
Name:MCCARTHY, TERI R (RN,MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:R
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:RN,MSW,LCSW
Other - Prefix:MISS
Other - First Name:TERI
Other - Middle Name:LEE
Other - Last Name:RIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSW, LCSW
Mailing Address - Street 1:745 OLD FRONTENAC SQ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2754
Mailing Address - Country:US
Mailing Address - Phone:314-707-7663
Mailing Address - Fax:314-721-6863
Practice Address - Street 1:745 OLD FRONTENAC SQ
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2754
Practice Address - Country:US
Practice Address - Phone:314-707-7663
Practice Address - Fax:314-721-6863
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0017831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical