Provider Demographics
NPI:1265637243
Name:ANTHONY-PETTER, JAMA GAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMA
Middle Name:GAY
Last Name:ANTHONY-PETTER
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 1:859 SHERILIN DR
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2324
Mailing Address - Country:US
Mailing Address - Phone:314-971-3051
Mailing Address - Fax:314-822-7562
Practice Address - Street 1:11222 TESSON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6963
Practice Address - Country:US
Practice Address - Phone:314-971-3051
Practice Address - Fax:314-822-7562
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0013341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOSWOO1334OtherLCSW