Provider Demographics
NPI:1558992826
Name:MONAHAN, MARY CLARE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY CLARE
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2514
Mailing Address - Country:US
Mailing Address - Phone:314-268-2700
Mailing Address - Fax:314-268-2748
Practice Address - Street 1:3800 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2514
Practice Address - Country:US
Practice Address - Phone:314-268-2700
Practice Address - Fax:314-268-2748
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180324781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical