| Independence Center | |
|
4219 Laclede Ave Suite B Saint Louis MO 63108-2814 | |
| (314) 286-4545 | |
| (314) 286-4542 |
| Full Name | Independence Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4219 Laclede Ave, Saint Louis, Missouri |
| Authorized Official Name and Position | Patricia Holmes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3148805415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Center 4245 Forest Park Ave Saint Louis MO 63108-2810 Ph: (314) 880-5401 | Independence Center 4219 Laclede Ave Suite B Saint Louis MO 63108-2814 Ph: (314) 286-4545 |
| NPI Number | 1174668289 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 06/27/2022 |
| Certification Date | 06/24/2022 |
| Medicare PECOS PAC ID | 1759341852 |
|---|---|
| Medicare Enrollment ID | O20051111000129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174668289 | NPI | - | NPPES |
| 503350506 | Medicaid | MO | |
| 560003943 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| Provider Name | Charles R Conway |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497771356 PECOS PAC ID: 5395824353 Enrollment ID: I20080502000306 |
| Provider Name | Sarah M Hartz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922216829 PECOS PAC ID: 5698826030 Enrollment ID: I20090625000299 |
| Provider Name | Barbara L Devos Schoenig |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164715306 PECOS PAC ID: 8628247475 Enrollment ID: I20110811000466 |
| Provider Name | Laura E Romer |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1477697746 PECOS PAC ID: 4688840069 Enrollment ID: I20120106000149 |
| Provider Name | Kacey Alexandra Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619433125 PECOS PAC ID: 6800138322 Enrollment ID: I20190503000476 |
| Provider Name | David N Daniels |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639512809 PECOS PAC ID: 2365744745 Enrollment ID: I20210428000552 |
| Provider Name | Carly Ann Masinelli |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598490724 PECOS PAC ID: 4981087103 Enrollment ID: I20220819001439 |
| Provider Name | Katherine Louise Denney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942927207 PECOS PAC ID: 1456728773 Enrollment ID: I20221029000210 |
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