Provider Demographics
NPI:1619665932
Name:KRIVDA, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:KRIVDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 PENN AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2672
Mailing Address - Country:US
Mailing Address - Phone:817-475-5865
Mailing Address - Fax:
Practice Address - Street 1:1079 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4723
Practice Address - Country:US
Practice Address - Phone:817-475-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor