Provider Demographics
NPI:1558439497
Name:PODELL, MAYDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAYDA
Middle Name:
Last Name:PODELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 EAGLES NEST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516
Mailing Address - Country:US
Mailing Address - Phone:845-896-3404
Mailing Address - Fax:845-265-7867
Practice Address - Street 1:40 EAGLES NEST
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516
Practice Address - Country:US
Practice Address - Phone:845-896-3404
Practice Address - Fax:845-265-7867
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19773104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67443Medicare UPIN
N6G861Medicare ID - Type Unspecified