Provider Demographics
NPI:1275749921
Name:MACGREEVY, JANE E
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:MACGREEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:MUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2650 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1424
Mailing Address - Country:US
Mailing Address - Phone:314-371-6500
Mailing Address - Fax:
Practice Address - Street 1:141 MARKET PL
Practice Address - Street 2:SUITE 206
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2034
Practice Address - Country:US
Practice Address - Phone:618-398-7250
Practice Address - Fax:618-398-6870
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0043101041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL383180Medicare ID - Type Unspecified