Provider Demographics
NPI:1114231214
Name:MADEIRA, WILLIAM M
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:MADEIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 W 30TH ST
Mailing Address - Street 2:RM 602
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4954
Mailing Address - Country:US
Mailing Address - Phone:484-788-9077
Mailing Address - Fax:
Practice Address - Street 1:242 W 30TH ST
Practice Address - Street 2:RM 602
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4954
Practice Address - Country:US
Practice Address - Phone:917-565-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-073781041C0700X
NY069753-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical