Provider Demographics
NPI:1699827998
Name:MADANSKY, CHARLES HERTZ (MED)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HERTZ
Last Name:MADANSKY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-8034
Mailing Address - Country:US
Mailing Address - Phone:508-896-9489
Mailing Address - Fax:508-896-9489
Practice Address - Street 1:196 NAN KE RAFE PATH
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-8034
Practice Address - Country:US
Practice Address - Phone:508-896-9489
Practice Address - Fax:508-896-9489
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health