Provider Demographics
NPI:1518264886
Name:MADISON MARRIAGE AND FAMILY THERAPY, PC
Entity Type:Organization
Organization Name:MADISON MARRIAGE AND FAMILY THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:646-205-7606
Mailing Address - Street 1:271 MADISON AVE
Mailing Address - Street 2:STE. 1400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1001
Mailing Address - Country:US
Mailing Address - Phone:646-205-7606
Mailing Address - Fax:
Practice Address - Street 1:271 MADISON AVE
Practice Address - Street 2:STE. 1400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1001
Practice Address - Country:US
Practice Address - Phone:646-205-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00733106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSSN
NY1114255510OtherNPPES