Provider Demographics
NPI:1982479655
Name:FURNESS, MADELYN GRACE (MHC-LP)
Entity Type:Individual
Prefix:MISS
First Name:MADELYN
Middle Name:GRACE
Last Name:FURNESS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 INTERLAKEN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-1202
Mailing Address - Country:US
Mailing Address - Phone:585-935-1716
Mailing Address - Fax:
Practice Address - Street 1:138 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-7714
Practice Address - Country:US
Practice Address - Phone:315-366-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health