Provider Demographics
NPI:1174629380
Name:CHERVITZ, ROBIN B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:B
Last Name:CHERVITZ
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 1:458 WHITESTONE FARM DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2465
Mailing Address - Country:US
Mailing Address - Phone:636-728-1201
Mailing Address - Fax:
Practice Address - Street 1:711 OLD BALLAS RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7051
Practice Address - Country:US
Practice Address - Phone:314-995-0040
Practice Address - Fax:314-569-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0012171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical