Active NPI
Mary Nye St.Clair, LCSW, ATR-BC, CGP
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1073576286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW00003838
- Practice address
- 7750 Clayton Rd
Suite 308 a
Saint Louis, MO 63117-1353 - Phone
- (314) 644-4422
- NPI assigned
- Apr 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW00003838 | MO | Primary |
Addresses
Primary practice location
7750 Clayton Rd
Suite 308 a
Saint Louis, MO 63117-1353
Mailing address
7750 Clayton Rd
Suite 308 a
Saint Louis, MO 63117-1353
Phone (314) 644-4422
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209651 | Other | MO | ANTHEM BCBS |
| 490614104 | Medicaid | MO |
Other names 1
- Mary Nye Gothberg
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW00003838 | MO | MD | Clinical Social Worker |
| 003838 | MO | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Residential Psychiatric Services, Inc. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Farmington, MO
- NPI 1467453894
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235692800000",
"number": "1073576286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7750 CLAYTON RD",
"address_2": "SUITE 308 A",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631171353",
"telephone_number": "314-644-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7750 CLAYTON RD",
"address_2": "SUITE 308 A",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631171353",
"telephone_number": "314-644-4422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ST.CLAIR",
"first_name": "MARY",
"middle_name": "NYE",
"credential": "LCSW, ATR-BC, CGP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-10",
"last_updated": "2009-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "SW00003838",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "209651",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "490614104",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "GOTHBERG",
"middle_name": "NYE",
"credential": "LCSW",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.