Provider Demographics
NPI:1760985980
Name:RABUSHKA, JOAN ELLEN (LMSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:RABUSHKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SPENCER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2574
Mailing Address - Country:US
Mailing Address - Phone:636-477-6111
Mailing Address - Fax:
Practice Address - Street 1:255 SPENCER RD STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2574
Practice Address - Country:US
Practice Address - Phone:636-477-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170380101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical