Provider Demographics
NPI:1114075298
Name:STRIED, AMY W (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:STRIED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:SUITE #120
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:SUITE #120
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63341
Practice Address - Country:US
Practice Address - Phone:314-878-6488
Practice Address - Fax:636-398-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO52191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO126873OtherBLUE CROSS BLUE SHIELD
MO405297OtherGHP-MHNET