Provider Demographics
NPI:1184225013
Name:REIMONDO, MADISON KATHLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KATHLEEN
Last Name:REIMONDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1158
Mailing Address - Country:US
Mailing Address - Phone:860-993-0289
Mailing Address - Fax:
Practice Address - Street 1:185 SILAS DEANE HWY STE 2
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1219
Practice Address - Country:US
Practice Address - Phone:860-874-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT011184101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT011184OtherLCSW