Provider Demographics
NPI:1821136383
Name:ARDEKANI, SHERVIN B (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHERVIN
Middle Name:B
Last Name:ARDEKANI
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 1:8025 BONHOMME AVE APT 1509
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3528
Mailing Address - Country:US
Mailing Address - Phone:314-721-3665
Mailing Address - Fax:314-843-8825
Practice Address - Street 1:10004 KENNERLY RD STE 310A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-5117
Practice Address - Country:US
Practice Address - Phone:314-843-3310
Practice Address - Fax:314-843-8825
Is Sole Proprietor?:No
Enumeration Date:2007-02-04
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070005111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
209580OtherBLUE CROSS BLUE SHIELD