Provider Demographics
NPI:1932417953
Name:NICOLAS, ROWNA MARGUERITE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROWNA
Middle Name:MARGUERITE
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ROWNA
Other - Middle Name:MARGUERITE
Other - Last Name:MATUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12647 OLIVE BLVD
Mailing Address - Street 2:600
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6393
Mailing Address - Country:US
Mailing Address - Phone:800-325-3982
Mailing Address - Fax:877-685-9866
Practice Address - Street 1:12647 OLIVE BLVD
Practice Address - Street 2:600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6393
Practice Address - Country:US
Practice Address - Phone:800-325-3982
Practice Address - Fax:877-685-9866
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW88561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical