Provider Demographics
NPI:1003643461
Name:FEZZI, KATHERINE (LMSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FEZZI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:BABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9904 CLAYTON RD STE 135
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1149
Mailing Address - Country:US
Mailing Address - Phone:314-222-5830
Mailing Address - Fax:
Practice Address - Street 1:9904 CLAYTON RD STE 135
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1149
Practice Address - Country:US
Practice Address - Phone:314-222-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024021246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker