Healthcare Provider Details

I. General information

NPI: 1659298453
Provider Name (Legal Business Name): MADELYN PETRUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 ALLWOOD RD STE 300
CLIFTON NJ
07012-1988
US

IV. Provider business mailing address

935 ALLWOOD RD STE 300
CLIFTON NJ
07012-1988
US

V. Phone/Fax

Practice location:
  • Phone: 973-495-5363
  • Fax: 973-707-2383
Mailing address:
  • Phone: 973-495-5363
  • Fax: 973-707-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00973900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: