Healthcare Provider Details

I. General information

NPI: 1629934542
Provider Name (Legal Business Name): ELEANOR ELIZABETH PANICOLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N EUCLID AVE
SAINT LOUIS MO
63115-1632
US

IV. Provider business mailing address

6626 MARDEL AVE
SAINT LOUIS MO
63109-1226
US

V. Phone/Fax

Practice location:
  • Phone: 314-385-9502
  • Fax:
Mailing address:
  • Phone: 314-769-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: