Provider Demographics
NPI:1891243655
Name:CARLSON-WIDOLFF, MADELEINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:CARLSON-WIDOLFF
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 1:600 W CAMPBELL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3357
Mailing Address - Country:US
Mailing Address - Phone:815-973-7117
Mailing Address - Fax:224-788-5112
Practice Address - Street 1:600 W CAMPBELL RD STE 1
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3357
Practice Address - Country:US
Practice Address - Phone:815-973-7117
Practice Address - Fax:224-788-5112
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490210291041C0700X
TX687511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical