Provider Demographics
NPI:1225649825
Name:NASSIDA, MADELINE MARIE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MARIE
Last Name:NASSIDA
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 1:2136 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3626
Mailing Address - Country:US
Mailing Address - Phone:412-427-0642
Mailing Address - Fax:
Practice Address - Street 1:615 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1901
Practice Address - Country:US
Practice Address - Phone:412-343-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019076103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist