Provider Demographics
NPI:1073659165
Name:RISSMAN, MARGARET WETHERFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:WETHERFORD
Last Name:RISSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 S BRENTWOOD BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1851
Mailing Address - Country:US
Mailing Address - Phone:314-962-0008
Mailing Address - Fax:314-963-8950
Practice Address - Street 1:2025 S BRENTWOOD BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1851
Practice Address - Country:US
Practice Address - Phone:314-962-0008
Practice Address - Fax:314-963-8950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00928103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO109458OtherBLUE CROSS BLUE SHIELD