Provider Demographics
NPI:1164075321
Name:PEARCE, MADELEINE L (BA IN APPLIES PHYCH)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:L
Last Name:PEARCE
Suffix:
Gender:F
Credentials:BA IN APPLIES PHYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LINDEN BLVD APT B23
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3427
Mailing Address - Country:US
Mailing Address - Phone:408-460-5199
Mailing Address - Fax:
Practice Address - Street 1:11506 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2346
Practice Address - Country:US
Practice Address - Phone:718-554-7766
Practice Address - Fax:718-945-7766
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator