Provider Demographics
NPI:1144371568
Name:MEHRA, ANITA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:MEHRA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240014
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63024-0014
Mailing Address - Country:US
Mailing Address - Phone:314-729-0837
Mailing Address - Fax:314-966-6065
Practice Address - Street 1:10000 WATSON RD STE 2L13
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1844
Practice Address - Country:US
Practice Address - Phone:314-729-0837
Practice Address - Fax:314-966-6065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040220791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499181204Medicaid
MO000082309Medicare ID - Type Unspecified