Provider Demographics
NPI:1811103096
Name:COLE, SIDNEY EDWARDS (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:EDWARDS
Last Name:COLE
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 1:4525 LINDELL BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2011
Mailing Address - Country:US
Mailing Address - Phone:314-361-6811
Mailing Address - Fax:
Practice Address - Street 1:4525 LINDELL BLVD APT 101
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2011
Practice Address - Country:US
Practice Address - Phone:314-361-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0013241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical