Provider Demographics
NPI:1235398132
Name:MISHKIN, STEVEN PHILLIP (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:PHILLIP
Last Name:MISHKIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10847 CHASE PARK LN APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5732
Mailing Address - Country:US
Mailing Address - Phone:314-692-4231
Mailing Address - Fax:314-692-4231
Practice Address - Street 1:655 CRAIG RD
Practice Address - Street 2:STE 320
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7171
Practice Address - Country:US
Practice Address - Phone:314-692-4231
Practice Address - Fax:314-692-4231
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060039541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical