Provider Demographics
NPI:1003049099
Name:PINKERTON, PHOEBE SUE (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:SUE
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63032-0735
Mailing Address - Country:US
Mailing Address - Phone:314-477-3165
Mailing Address - Fax:314-921-9834
Practice Address - Street 1:3820 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-2928
Practice Address - Country:US
Practice Address - Phone:314-477-3165
Practice Address - Fax:314-921-9834
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical