Provider Demographics
NPI:1982122503
Name:PIELERT, MADELINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:PIELERT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 HUNTINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5971
Mailing Address - Country:US
Mailing Address - Phone:612-990-5162
Mailing Address - Fax:
Practice Address - Street 1:1486 HUNTINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5971
Practice Address - Country:US
Practice Address - Phone:612-990-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW789651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical