MEDICARE: ELYSE M DEMADALER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R O43725	NY

General Provider Information

NPI Number	:	1881601011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSE M DEMADALER LCSW

Provider Business Mailing Address
First Line	:	6 SUSAN CT
Second Line	:
City	:	HYDE PARK
State	:	NY
Zip	:	12538-2218
Country	:	US
Telephone Number	:	845-229-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 SUSAN CT
Second Line	:
City	:	HYDE PARK
State	:	NY
Zip	:	12538-2218
Country	:	US
Telephone Number	:	845-797-2383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	09/26/2011

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