Provider Demographics
NPI:1639160062
Name:PENBERTHY, CAROLINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:PENBERTHY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 OLD BIG BEND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6844
Mailing Address - Country:US
Mailing Address - Phone:314-909-0211
Mailing Address - Fax:314-909-0323
Practice Address - Street 1:12166 OLD BIG BEND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6844
Practice Address - Country:US
Practice Address - Phone:314-909-0211
Practice Address - Fax:314-909-0323
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0008021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO472758OtherHEALTHLINK
MOR01055OtherMERCY HEALTH PLANS
MO6236004OtherUNITED BEHAVIORAL HEALTH
MO125668OtherBLUE CROSS BLUE SHIELD
MOO62230OtherEXCLUSIVE CHOICE