MEDICARE: PINKIE MAXWELL-GREEN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1164374062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PINKIE MAXWELL-GREEN

Provider Business Mailing Address
First Line	:	3309 S KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-1101
Country	:	US
Telephone Number	:	314-206-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 GRAHAM RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8077
Country	:	US
Telephone Number	:	314-206-3700
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ PINKIE MAXWELL-GREEN ” Practice Location

Language	Start Address	Practice Location

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