Provider Demographics
NPI:1730483041
Name:BOSHART, CAROL RIEGLER (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RIEGLER
Last Name:BOSHART
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 1:402 E GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4845
Mailing Address - Country:US
Mailing Address - Phone:314-852-9051
Mailing Address - Fax:
Practice Address - Street 1:2025 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1833
Practice Address - Country:US
Practice Address - Phone:314-963-8900
Practice Address - Fax:314-963-8950
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0024501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical