1821136383 NPI number — SHERVIN B ARDEKANI MSW, LCSW

Table of content: SHERVIN B ARDEKANI MSW, LCSW (NPI 1821136383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821136383 NPI number — SHERVIN B ARDEKANI MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARDEKANI
Provider First Name:
SHERVIN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821136383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8025 BONHOMME AVE APT 1509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-3528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-721-3665
Provider Business Mailing Address Fax Number:
314-843-8825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10004 KENNERLY RD STE 310A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-843-3310
Provider Business Practice Location Address Fax Number:
314-843-8825
Provider Enumeration Date:
02/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2007000511 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209580 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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