Provider Demographics
NPI:1609066133
Name:SADWIN, PHYLLIS FINE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:FINE
Last Name:SADWIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:L
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:443 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6800
Mailing Address - Country:US
Mailing Address - Phone:314-922-7754
Mailing Address - Fax:314-576-1343
Practice Address - Street 1:443 N NEW BALLAS RD
Practice Address - Street 2:SUITE222
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-922-7754
Practice Address - Fax:314-576-1343
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0023451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000077704Medicare PIN