Provider Demographics
NPI:1407348964
Name:EMERY, MADELINE PAIGE (BSW,LSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:PAIGE
Last Name:EMERY
Suffix:
Gender:F
Credentials:BSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SUMMIT AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3653
Mailing Address - Country:US
Mailing Address - Phone:330-717-2001
Mailing Address - Fax:
Practice Address - Street 1:3620 STUTZ DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-286-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802099104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker