Healthcare Provider Details

I. General information

NPI: 1831409309
Provider Name (Legal Business Name): AMELIA MAYADENU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 3015B
SAINT LOUIS MO
63141-8267
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 3015B
SAINT LOUIS MO
63141-8267
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-2900
  • Fax: 314-251-2901
Mailing address:
  • Phone: 314-251-2900
  • Fax: 314-251-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149016341
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114761
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2014010304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: