Provider Demographics
NPI:1457510455
Name:SAVAGE, MADELINE T (LISW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:T
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:T
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:452 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1556
Mailing Address - Country:US
Mailing Address - Phone:330-480-2866
Mailing Address - Fax:330-480-4084
Practice Address - Street 1:452 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1556
Practice Address - Country:US
Practice Address - Phone:330-480-2866
Practice Address - Fax:330-480-4084
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 080001531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215416Medicaid