MEDICARE: MRS. MAUREEN ANN ELLIS MSW, 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	104100000X	Social Worker	001878	MO
2	1041C0700X	Clinical Social Worker	001878	MO

General Provider Information

NPI Number	:	1912045386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN ANN ELLIS MSW, LCSW

Provider Business Mailing Address
First Line	:	12054 DEPAUL HILLS DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-3511
Country	:	US
Telephone Number	:	314-298-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	12054 DEPAUL HILLS DR
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-3511
Country	:	US
Telephone Number	:	314-298-0808
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/11/2025

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