Provider Demographics
NPI:1225175649
Name:GREENWALD, SUZANNE (LCSW MSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FARKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW MSW
Mailing Address - Street 1:836 BARKLEY SQ
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:314-725-5429
Mailing Address - Fax:
Practice Address - Street 1:225 MERAMEC
Practice Address - Street 2:STE 932T
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:314-863-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0026621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO280278OtherVALUE OPTIONS