Provider Demographics
NPI:1659590354
Name:MADRID, JOSEPH A (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:MADRID
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3133
Mailing Address - Country:US
Mailing Address - Phone:307-637-3953
Mailing Address - Fax:307-638-6805
Practice Address - Street 1:604 E 25TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3133
Practice Address - Country:US
Practice Address - Phone:307-637-3953
Practice Address - Fax:307-638-6805
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical