Active NPI
Genevieve Anne Distasio
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1407708340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 004717
- Practice address
- 5367 Pershing Ave Apt 4
Saint Louis, MO 63112-1785 - Phone
- (314) 606-8837
- NPI assigned
- Feb 12, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149.002027 | IL | |
| Clinical Social Worker | 1041C0700X | 004717 | Primary |
Addresses
Primary practice location
5367 Pershing Ave Apt 4
Saint Louis, MO 63112-1785
Mailing address
5367 Pershing Ave Apt 4
Saint Louis, MO 63112-1785
Phone (314) 606-8837
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149.002027 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1770854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770854400000",
"number": "1407708340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5367 PERSHING AVE APT 4",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631121785",
"telephone_number": "314-606-8837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5367 PERSHING AVE APT 4",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631121785",
"telephone_number": "314-606-8837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISTASIO",
"first_name": "GENEVIEVE",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-02-12",
"last_updated": "2026-02-12",
"certification_date": "2026-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149.002027",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": "004717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.