Provider Demographics
NPI:1033355847
Name:BOBADILLA, MARIA DEL ROSARIO (LSCW)
Entity Type:Individual
Prefix:
First Name:MARIA DEL ROSARIO
Middle Name:
Last Name:BOBADILLA
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3120
Mailing Address - Country:US
Mailing Address - Phone:314-814-8722
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:100 N TUCKER BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-1931
Practice Address - Country:US
Practice Address - Phone:314-814-8722
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005038337Medicaid