Provider Demographics
NPI:1154450088
Name:BUDD-DARBY, VICKI (MSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:BUDD-DARBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4543
Mailing Address - Country:US
Mailing Address - Phone:314-510-6056
Mailing Address - Fax:
Practice Address - Street 1:6403 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1810
Practice Address - Country:US
Practice Address - Phone:314-495-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOSW0053871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6290563OtherUNITED HEALTH CARE
MO119695OtherBLUE CROSS BLUE SHILED
MO6290563OtherUNITED HEALTH CARE