Provider Demographics
NPI:1760720585
Name:ANTHONY J. MADONIA, LCSW
Entity Type:Organization
Organization Name:ANTHONY J. MADONIA, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MADONIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-471-8000
Mailing Address - Street 1:PO BOX 7253
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60507-7253
Mailing Address - Country:US
Mailing Address - Phone:847-471-8000
Mailing Address - Fax:630-352-3242
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:#203
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:847-471-8000
Practice Address - Fax:630-352-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0125851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty