Provider Demographics
NPI:1609561612
Name:CONETTA, MADALYN ESTHER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:ESTHER
Last Name:CONETTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:ESTHER
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 CAPITAL CIR SE STE 18230
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3802
Mailing Address - Country:US
Mailing Address - Phone:850-583-1903
Mailing Address - Fax:
Practice Address - Street 1:317 N GADSDEN ST STE 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7615
Practice Address - Country:US
Practice Address - Phone:850-583-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW111741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical