Provider Demographics
NPI:1922217538
Name:NELSON, MADELEINE KAY (MSW)
Entity Type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20700 EDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5214
Mailing Address - Country:US
Mailing Address - Phone:510-886-8054
Mailing Address - Fax:
Practice Address - Street 1:2500 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1006
Practice Address - Country:US
Practice Address - Phone:510-667-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW058581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical