Basic Information
| Provider Information | |||||||||
| NPI: | 1215350012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAFFLY-KIPP | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 SAINT ALFRED RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631324119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149919951 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 231 W LOCKWOOD AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631192951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147374070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2013029929 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.