| Creative Change, Llc | |
|
8772 Big Bend Blvd Saint Louis MO 63119-3730 | |
| (314) 962-7788 | |
| (314) 962-4158 |
| Full Name | Creative Change, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8772 Big Bend Blvd, Saint Louis, Missouri |
| Authorized Official Name and Position | Doris Bender (MANAGED CARE COORDINATOR) |
| Authorized Official Contact | 3149627788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creative Change, Llc 8772 Big Bend Blvd Saint Louis MO 63119-3730 Ph: (314) 962-7788 | Creative Change, Llc 8772 Big Bend Blvd Saint Louis MO 63119-3730 Ph: (314) 962-7788 |
| NPI Number | 1760515498 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4082714092 |
|---|---|
| Medicare Enrollment ID | O20070705000115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760515498 | NPI | - | NPPES |
| Provider Name | Felix T Vincenz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942244629 PECOS PAC ID: 6305749193 Enrollment ID: I20050819000832 |
| Provider Name | Robert S Rosen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265560734 PECOS PAC ID: 9830280163 Enrollment ID: I20070801000172 |
| Provider Name | Karol A Kiel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255438883 PECOS PAC ID: 2668504275 Enrollment ID: I20100717000106 |
| Provider Name | Patricia M Boever |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073568069 PECOS PAC ID: 0446350458 Enrollment ID: I20100721000160 |
| Provider Name | Timothy J Jovick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174620793 PECOS PAC ID: 5698809531 Enrollment ID: I20100814000135 |
| Provider Name | Michael Ml Krownapple |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568779189 PECOS PAC ID: 8820262330 Enrollment ID: I20111118000486 |
| Provider Name | Patricia A Ferrugia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104285246 PECOS PAC ID: 8820370232 Enrollment ID: I20170119002178 |
| Provider Name | Christine Kane Bertolino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295307692 PECOS PAC ID: 0042615148 Enrollment ID: I20210827002222 |
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