Provider Demographics
NPI:1093440463
Name:MADONIA, ELIZABETH (LMHC,)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MADONIA
Suffix:
Gender:F
Credentials:LMHC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 HUSSON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3438
Mailing Address - Country:US
Mailing Address - Phone:917-670-4508
Mailing Address - Fax:
Practice Address - Street 1:356 HUSSON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3438
Practice Address - Country:US
Practice Address - Phone:917-670-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760618101YS0200X
NY012411-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool