Healthcare Provider Details

I. General information

NPI: 1770869901
Provider Name (Legal Business Name): MADELEINE LANSKY, MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE SUITE 601
SAN FRANCISCO CA
94117-3608
US

IV. Provider business mailing address

350 PARNASSUS AVE SUITE 601
SAN FRANCISCO CA
94117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 415-820-3242
  • Fax:
Mailing address:
  • Phone: 415-820-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA070420
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA70420
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberA70420
License Number StateCA

VIII. Authorized Official

Name: DR. MADELEINE LANSKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-820-3242