Provider Demographics
NPI:1629802517
Name:BARGETZI, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:BARGETZI
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 1:24 PARTRIDGE HL
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1734
Mailing Address - Country:US
Mailing Address - Phone:201-819-8467
Mailing Address - Fax:
Practice Address - Street 1:79 N FRANKLIN TPKE STE 107
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2029
Practice Address - Country:US
Practice Address - Phone:201-749-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07158500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker