Healthcare Provider Details

I. General information

NPI: 1992240352
Provider Name (Legal Business Name): MADALYN HARVEY BERENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 WASHTENAW RD
YPSILANTI MI
48197-1706
US

IV. Provider business mailing address

2046 WASHTENAW RD
YPSILANTI MI
48197-1706
US

V. Phone/Fax

Practice location:
  • Phone: 734-768-0968
  • Fax:
Mailing address:
  • Phone: 734-768-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106995
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801102191
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: