MEDICARE: JENNIFER E MADERA LMSW

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
2	104100000X	Social Worker	110337	NY

General Provider Information

NPI Number	:	1942897855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E MADERA LMSW

Provider Business Mailing Address
First Line	:	2527 GLEBE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-3109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2661 DECATUR AVE APT 2D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4241
Country	:	US
Telephone Number	:	347-557-3107
Fax Number	:

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

Provider Enumeration Date	:	12/26/2020
Last Update Date	:	07/19/2021

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