Provider Demographics
NPI:1326425612
Name:MADDEN, WILLIAM (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 GRAND CONCOURSE
Mailing Address - Street 2:APT 23N
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2605
Mailing Address - Country:US
Mailing Address - Phone:646-637-2106
Mailing Address - Fax:
Practice Address - Street 1:1020 GRAND CONCOURSE
Practice Address - Street 2:APT 23N
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2605
Practice Address - Country:US
Practice Address - Phone:646-637-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0489981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY048998OtherLICENSED CLINICAL SOCIAL WORKER