Provider Demographics
NPI:1871712729
Name:FLEMING, PATRICK J (MDIV, MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MDIV, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S CLAY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5860
Mailing Address - Country:US
Mailing Address - Phone:314-822-9696
Mailing Address - Fax:314-822-9696
Practice Address - Street 1:412 S CLAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5860
Practice Address - Country:US
Practice Address - Phone:314-822-9696
Practice Address - Fax:314-822-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0001731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical