Provider Demographics
NPI:1851714687
Name:OSORIO, SHELLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:OSORIO
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 1:5000 CEDAR PLAZA PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3854
Mailing Address - Country:US
Mailing Address - Phone:314-843-4333
Mailing Address - Fax:314-842-0772
Practice Address - Street 1:763 S NEW BALLAS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8704
Practice Address - Country:US
Practice Address - Phone:314-569-1717
Practice Address - Fax:314-569-0441
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130012391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical