Provider Demographics
NPI:1922743772
Name:URRARO, MADISON LEIGH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MADISON
Middle Name:LEIGH
Last Name:URRARO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4314
Mailing Address - Country:US
Mailing Address - Phone:631-375-4119
Mailing Address - Fax:
Practice Address - Street 1:6500 JERICHO TPKE STE 217
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2907
Practice Address - Country:US
Practice Address - Phone:631-543-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112777-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty