Provider Demographics
NPI:1417656349
Name:JENNINGS, MADISON (CBD, CPD)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CBD, CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CHURCH AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3734
Mailing Address - Country:US
Mailing Address - Phone:917-770-0694
Mailing Address - Fax:
Practice Address - Street 1:58 CHURCH AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3734
Practice Address - Country:US
Practice Address - Phone:917-770-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula