Provider Demographics
NPI:1720821127
Name:DISTEFANO, DENA (LCSW, CCTP, C-DBT)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:LCSW, CCTP, C-DBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 PEARSON POINTE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1699
Mailing Address - Country:US
Mailing Address - Phone:314-369-8009
Mailing Address - Fax:
Practice Address - Street 1:3579 PEARSON POINTE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1699
Practice Address - Country:US
Practice Address - Phone:314-369-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070344911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical