Provider Demographics
NPI:1326287772
Name:ACHTENBERG, JOEL F (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:F
Last Name:ACHTENBERG
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2617
Mailing Address - Country:US
Mailing Address - Phone:314-550-2766
Mailing Address - Fax:
Practice Address - Street 1:322 MARION AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2617
Practice Address - Country:US
Practice Address - Phone:314-550-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010040801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical