Provider Demographics
NPI:1245124536
Name:RETANA, MADELIN
Entity type:Individual
Prefix:
First Name:MADELIN
Middle Name:
Last Name:RETANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4809
Mailing Address - Country:US
Mailing Address - Phone:914-500-9849
Mailing Address - Fax:
Practice Address - Street 1:128 SPRING ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4809
Practice Address - Country:US
Practice Address - Phone:914-500-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool