Tina M Dale, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2004010098 Issued in MO

Practice address

8420 Delmar Blvd Ste 209
Saint Louis, MO 63124-2177

Phone

(314) 477-8751

Fax

(314) 983-0331

NPI assigned

Jun 24, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Mercy Professional Services, Inc.

  • Clinical Social Worker
  • Saint Louis, MO
  • NPI 1649305418
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124054804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8420 DELMAR BLVD STE 209",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631242177",
            "telephone_number": "314-477-8751",
            "fax_number": "314-983-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8420 DELMAR BLVD STE 209",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631242177",
            "telephone_number": "314-477-8751",
            "fax_number": "314-983-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "TINA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2004010098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD, A",
            "identifier": "190570",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER NUMBER",
            "identifier": "1133370",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corrine Ann Dale, MD
• Josh Alan Dale, RD, LD
• Kimberly Dache Dale, DOT
• Lynn Dale
• Ryan James Dale
• Sarah Daleo
• Nichole Dales
• Lisa Gaye Daley, APRN, BC
• Andrew Robert Dalin, DDS
• Shiv Dalla, MD

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.