Provider Demographics
NPI:1508945981
Name:CENTERS FOR PROFESSIONAL AND PASTORAL SERVICE
Entity Type:Organization
Organization Name:CENTERS FOR PROFESSIONAL AND PASTORAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TEMPORITI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-776-1319
Mailing Address - Street 1:4949 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1013
Mailing Address - Country:US
Mailing Address - Phone:314-776-1319
Mailing Address - Fax:314-776-1319
Practice Address - Street 1:141 N MERAMEC AVE
Practice Address - Street 2:#205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3750
Practice Address - Country:US
Practice Address - Phone:314-776-1319
Practice Address - Fax:314-776-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00007817Medicare ID - Type Unspecified