Provider Demographics
NPI:1619575503
Name:SKIBA-MATHEWS, RITA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:SKIBA-MATHEWS
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 1:4203 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3510
Mailing Address - Country:US
Mailing Address - Phone:513-532-6577
Mailing Address - Fax:
Practice Address - Street 1:1329 MACKLIND AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1400
Practice Address - Country:US
Practice Address - Phone:314-728-3630
Practice Address - Fax:314-645-7802
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200329041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical