Active NPI
Derrick Skinner Sr., LCSW
- Social Worker
- Saint Louis, MO
National Provider Identifier
1992034672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 1041
- Practice address
- 12647 Olive Blvd
Ste 600
Saint Louis, MO 63141-6393 - Phone
- (800) 325-3982
- Fax
- (877) 685-9880
- NPI assigned
- Dec 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 2406 | NE | |
| Clinical Social Worker | 1041C0700X | 2406 | NE | |
| Clinical Social Worker | 1041C0700X | 1041 | NE | |
| Social Worker | 104100000X | 1041 | NE | Primary |
Addresses
Primary practice location
12647 Olive Blvd
Ste 600
Saint Louis, MO 63141-6393
Mailing address
USA Meddac
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Phone (315) 772-3173
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 |
|---|---|---|---|
| 1041 | NE | MD | Mental Health Counselor |
| 2406 | NE | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644969600000",
"number": "1992034672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "USA MEDDAC",
"address_2": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "315-772-3173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12647 OLIVE BLVD",
"address_2": "STE 600",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416393",
"telephone_number": "800-325-3982",
"fax_number": "877-685-9880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKINNER",
"first_name": "DERRICK",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-09",
"last_updated": "2022-02-16",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NE",
"license": "2406",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "2406",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NE",
"license": "1041",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NE",
"license": "1041",
"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 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.