Provider Demographics
NPI:1790219566
Name:BRECKINRIDGE, MADELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:BRECKINRIDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 55TH ST APT 1T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5126
Mailing Address - Country:US
Mailing Address - Phone:917-957-5277
Mailing Address - Fax:
Practice Address - Street 1:360 W 55TH ST APT 1T
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5126
Practice Address - Country:US
Practice Address - Phone:917-957-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR017656OtherNEW YORK STATE LICENSE