Provider Demographics
NPI:1043696016
Name:ELLBERGER, MADELAINE BRETT (LMSW, MSED)
Entity Type:Individual
Prefix:MS
First Name:MADELAINE
Middle Name:BRETT
Last Name:ELLBERGER
Suffix:
Gender:F
Credentials:LMSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 68TH RD
Mailing Address - Street 2:APARTMENT A41
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3200
Mailing Address - Country:US
Mailing Address - Phone:862-251-1894
Mailing Address - Fax:
Practice Address - Street 1:10326 68TH RD
Practice Address - Street 2:APARTMENT A41
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3200
Practice Address - Country:US
Practice Address - Phone:862-251-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095304104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker