Provider Demographics
NPI:1790136216
Name:CORNERSTONE THERAPY SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-596-2049
Mailing Address - Street 1:7905 BIG BEND BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2715
Mailing Address - Country:US
Mailing Address - Phone:314-596-2049
Mailing Address - Fax:
Practice Address - Street 1:7905 BIG BEND BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2715
Practice Address - Country:US
Practice Address - Phone:314-596-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015043579305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service