Provider Demographics
NPI:1093082554
Name:MADAN, MARJORIE ELIZABETH (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ELIZABETH
Last Name:MADAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 CHRISTIAN HERALD ROAD
Mailing Address - Street 2:NYACK HIGH SCHOOL
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-353-7131
Mailing Address - Fax:845-353-7119
Practice Address - Street 1:360 CHRISTIAN HERALD ROAD
Practice Address - Street 2:NYACK HIGH SCHOOL
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-353-7131
Practice Address - Fax:845-353-7119
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0702731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical