Healthcare Provider Details

I. General information

NPI: 1366367237
Provider Name (Legal Business Name): MADELINE BLINDERMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 PRATT ST
GLASTONBURY CT
06033-1014
US

IV. Provider business mailing address

26 PEBBLE BEACH DR
BLOOMFIELD CT
06002-2922
US

V. Phone/Fax

Practice location:
  • Phone: 860-743-1657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8870
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: