Provider Demographics
NPI:1003686825
Name:NEUFELD-WALL, MARY BETH E (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:E
Last Name:NEUFELD-WALL
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 1:6519 SCANLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2403
Mailing Address - Country:US
Mailing Address - Phone:618-482-7330
Mailing Address - Fax:
Practice Address - Street 1:505 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2919
Practice Address - Country:US
Practice Address - Phone:618-482-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490261481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical