Provider Demographics
NPI:1013153584
Name:MADIMENOS, CHRISAFO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISAFO
Middle Name:
Last Name:MADIMENOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BAY RIDGE AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5076
Mailing Address - Country:US
Mailing Address - Phone:646-872-0049
Mailing Address - Fax:
Practice Address - Street 1:26 BAY RIDGE AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5076
Practice Address - Country:US
Practice Address - Phone:646-872-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012256-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist