Provider Demographics
NPI:1235318270
Name:MADINE, LAURENE L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURENE
Middle Name:L
Last Name:MADINE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAURENE
Other - Middle Name:M
Other - Last Name:DEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1 PRIORITY LN
Mailing Address - Street 2:# 306
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-6613
Mailing Address - Country:US
Mailing Address - Phone:724-497-2227
Mailing Address - Fax:
Practice Address - Street 1:1 PRIORITY LN
Practice Address - Street 2:# 306
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-6613
Practice Address - Country:US
Practice Address - Phone:724-497-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0174121041C0700X, 1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program