Provider Demographics
NPI:1740514819
Name:MAIDENBERG, MICHELLE P (PHD, MPH, LCSW-R)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:P
Last Name:MAIDENBERG
Suffix:
Gender:F
Credentials:PHD, MPH, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5201
Mailing Address - Country:US
Mailing Address - Phone:914-421-1500
Mailing Address - Fax:914-421-1501
Practice Address - Street 1:1241 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5201
Practice Address - Country:US
Practice Address - Phone:914-421-1500
Practice Address - Fax:914-421-1501
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0492131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical