Provider Demographics
NPI:1790899052
Name:MINDEK, MADELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:
Last Name:MINDEK
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 1:21685 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5927
Mailing Address - Country:US
Mailing Address - Phone:408-973-1001
Mailing Address - Fax:408-973-9164
Practice Address - Street 1:21685 GRANADA AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5927
Practice Address - Country:US
Practice Address - Phone:408-973-1001
Practice Address - Fax:408-973-9164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW #8376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health