Provider Demographics
NPI:1639321367
Name:MADWID, RICHARD WILLIAM (MS,LPC,LADC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:MADWID
Suffix:
Gender:M
Credentials:MS,LPC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LINDBERG ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2018
Mailing Address - Country:US
Mailing Address - Phone:203-449-2577
Mailing Address - Fax:
Practice Address - Street 1:153 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2559
Practice Address - Country:US
Practice Address - Phone:203-449-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000199101YA0400X
CT000273101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional