Provider Demographics
NPI:1023867231
Name:LAWDER, CARINA FAITH (MSW, LMSW, MAPS)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:FAITH
Last Name:LAWDER
Suffix:
Gender:F
Credentials:MSW, LMSW, MAPS
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:FAITH
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW, MAPS
Mailing Address - Street 1:4096 HAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2845
Mailing Address - Country:US
Mailing Address - Phone:408-693-6315
Mailing Address - Fax:
Practice Address - Street 1:4096 HAVEN ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2845
Practice Address - Country:US
Practice Address - Phone:408-693-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP1600X
MO20230211361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral