Provider Demographics
NPI:1841642030
Name:WEISS, MADELIN (LMSW)
Entity type:Individual
Prefix:
First Name:MADELIN
Middle Name:
Last Name:WEISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5860
Mailing Address - Country:US
Mailing Address - Phone:646-206-6823
Mailing Address - Fax:
Practice Address - Street 1:2415 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3538
Practice Address - Country:US
Practice Address - Phone:718-863-4100
Practice Address - Fax:718-863-5165
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035393104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker