MEDICARE: HANNAH MAGDALENE29 PAUL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2023009660	MO

General Provider Information

NPI Number	:	1811763592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH MAGDALENE29 PAUL LCSW

Provider Business Mailing Address
First Line	:	1847 BOULDER SPRINGS DR APT J
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3954
Country	:	US
Telephone Number	:	314-882-4390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 BOULDER SPRINGS DRIVE
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63146
Country	:	US
Telephone Number	:	314-384-9689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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