Provider Demographics
NPI:1194197863
Name:GINOCCHIO, SUSAN (PLPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GINOCCHIO
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 OLIVE BLVD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3215
Mailing Address - Country:US
Mailing Address - Phone:314-994-9344
Mailing Address - Fax:314-994-3007
Practice Address - Street 1:11600 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-4691
Practice Address - Country:US
Practice Address - Phone:314-994-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014014455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional