Active NPI
Forrest Ceballos, LCSW
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1679913172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 004646
- Practice address
- 1 Brookings Dr
Saint Louis, MO 63130-4862 - Phone
- (314) 935-6649
- Fax
- (314) 935-8515
- NPI assigned
- Jun 28, 2013
- Sex
- Male
- Sole proprietor
- No
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 | 004646 | MO | Primary |
Addresses
Primary practice location
1 Brookings Dr
Saint Louis, MO 63130-4862
Mailing address
1201 Brookings Dr
C B 1201
Saint Louis, MO 63130
Phone (314) 935-6666
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 |
|---|---|---|---|
| 004646 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1679913172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 BROOKINGS DR",
"address_2": "C B 1201",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "63130",
"telephone_number": "314-935-6666",
"fax_number": "314-935-5781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKINGS DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631304862",
"telephone_number": "314-935-6649",
"fax_number": "314-935-8515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEBALLOS",
"first_name": "FORREST",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-28",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "004646",
"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 Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.