Active NPI
Melinda Sue Kavanaugh, LCSW
- Social Worker
- Saint Louis, MO
National Provider Identifier
1871510404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 2005003884
- Practice address
- 517 S Euclid Ave
Saint Louis, MO 63110-1007 - Phone
- (314) 362-6908
- Fax
- (314) 747-3258
- NPI assigned
- Jul 17, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 2005003884 | MO | Primary |
Addresses
Primary practice location
517 S Euclid Ave
Saint Louis, MO 63110-1007
Mailing address
PO Box 8221
7425 Forsyth
Saint Louis, MO 63156-8221
Phone (314) 935-0770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 197032 | Other | MO-BLUE SHIELD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005003884 | MO | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871510404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8221",
"address_2": "7425 FORSYTH",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631568221",
"telephone_number": "314-935-0770",
"fax_number": "314-935-0575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "517 S EUCLID AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101007",
"telephone_number": "314-362-6908",
"fax_number": "314-747-3258"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAUGH",
"first_name": "MELINDA",
"middle_name": "SUE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MO",
"license": "2005003884",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MO-BLUE SHIELD",
"identifier": "197032",
"state": null
}
],
"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 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.