Provider Demographics
NPI:1285860627
Name:WARSHAW, SUSAN O (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:O
Last Name:WARSHAW
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 CLAYTON ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-646-7064
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-646-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0002561041C0700X
MO300076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist