Provider Demographics
NPI:1295863918
Name:STAFFORD, MADALENE MARY (MS NCC LPC LMHC)
Entity Type:Individual
Prefix:MISS
First Name:MADALENE
Middle Name:MARY
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MS NCC LPC LMHC
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Other - First Name:
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Mailing Address - Street 1:423 TRAVERSE BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1130
Mailing Address - Country:US
Mailing Address - Phone:716-876-6501
Mailing Address - Fax:
Practice Address - Street 1:206 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2398
Practice Address - Country:US
Practice Address - Phone:716-847-2441
Practice Address - Fax:716-847-0337
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001180-1101YM0800X
DCPRC 531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional