Provider Demographics
NPI:1487190567
Name:SIMOKAITIS, MARY KATHLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:SIMOKAITIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:SIMOKAITIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:615 SOUTH NEW BALLAS
Mailing Address - Street 2:YG230
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-5399
Mailing Address - Fax:314-251-5552
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:YG230
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-5399
Practice Address - Fax:314-251-5552
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001479171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator