Active NPI
Melissa Anne Peterson, LICSW
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1811211139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2016021511
- Practice address
- 9909 Clayton Rd
Suite Ll2A
Saint Louis, MO 63124-1120 - Phone
- (314) 649-2416
- NPI assigned
- Mar 15, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 115640 | MA | |
| Clinical Social Worker | 1041C0700X | 2016021511 | MO | Primary |
Addresses
Primary practice location
9909 Clayton Rd
Suite Ll2A
Saint Louis, MO 63124-1120
Mailing address
9909 Clayton Rd
Suite Ll2A
Saint Louis, MO 63124-1120
Phone (314) 649-2416
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 |
|---|---|---|---|
| 115640 | MA | MD | Clinical Social Worker |
| 2016021511 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484870400000",
"number": "1811211139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9909 CLAYTON RD",
"address_2": "SUITE LL2A",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631241120",
"telephone_number": "314-649-2416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9909 CLAYTON RD",
"address_2": "SUITE LL2A",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631241120",
"telephone_number": "314-649-2416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "MELISSA",
"middle_name": "ANNE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-15",
"last_updated": "2017-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "115640",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "2016021511",
"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 Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.