Provider Demographics
NPI:1376831701
Name:LEVEILLE, MADELEINE (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 BROAD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1345
Mailing Address - Country:US
Mailing Address - Phone:860-287-1322
Mailing Address - Fax:
Practice Address - Street 1:758 BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1345
Practice Address - Country:US
Practice Address - Phone:860-287-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT831103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling