Provider Demographics
NPI:1558404715
Name:MADDEN, ALEXANDRA SYDNEY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:SYDNEY
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:SYDNEY
Other - Last Name:MULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:5 PINE WEST PLZ
Mailing Address - Street 2:SUITE 508
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5593
Mailing Address - Country:US
Mailing Address - Phone:518-858-2330
Mailing Address - Fax:518-452-4233
Practice Address - Street 1:1044 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12307-1508
Practice Address - Country:US
Practice Address - Phone:518-370-1441
Practice Address - Fax:518-395-9431
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0579181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331833OtherMEDICARE OSCAR
NY057918ROtherPROFESSIONAL LICENSE NUMBER
NY53099AOtherMEDICARE PIN
NY02995513Medicaid