Provider Demographics
NPI:1396910972
Name:KRESKI, MARY ANN (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:KRESKI
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 1:9112 IONE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6428
Mailing Address - Country:US
Mailing Address - Phone:314-544-7334
Mailing Address - Fax:
Practice Address - Street 1:9112 IONE LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6428
Practice Address - Country:US
Practice Address - Phone:314-544-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0004021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical