Provider Demographics
NPI:1255186433
Name:MADEIRA, TAINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TAINA
Middle Name:
Last Name:MADEIRA
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 1:65 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5415
Mailing Address - Country:US
Mailing Address - Phone:140-199-6204
Mailing Address - Fax:
Practice Address - Street 1:65 ENGLEWOOD AVE APT 3
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5415
Practice Address - Country:US
Practice Address - Phone:401-996-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW033741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical