Provider Demographics
NPI:1376892463
Name:MADRID, MARIA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:D
Last Name:MADRID
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NEWPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1121
Mailing Address - Country:US
Mailing Address - Phone:516-510-3980
Mailing Address - Fax:
Practice Address - Street 1:171 NEWPORT ROAD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1121
Practice Address - Country:US
Practice Address - Phone:516-510-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0771801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical