Provider Demographics
NPI:1477380483
Name:PERRETTA, MADISON PAIGE (LISW, LCSW)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:PERRETTA
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16115-3108
Mailing Address - Country:US
Mailing Address - Phone:724-480-2630
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2102726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker