Provider Demographics
NPI:1508120643
Name:TEIXEIRA, MADELINE MARIE (MS, ED)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MARIE
Last Name:TEIXEIRA
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2316
Mailing Address - Country:US
Mailing Address - Phone:914-358-4460
Mailing Address - Fax:
Practice Address - Street 1:114 LONGVIEW AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2316
Practice Address - Country:US
Practice Address - Phone:914-358-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3881061174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator