Provider Demographics
NPI:1093428203
Name:MADRONERO, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MADRONERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1541
Mailing Address - Country:US
Mailing Address - Phone:516-636-9376
Mailing Address - Fax:
Practice Address - Street 1:16318 JAMAICA AVE STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4901
Practice Address - Country:US
Practice Address - Phone:917-745-2836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker