Healthcare Provider Details

I. General information

NPI: 1497378277
Provider Name (Legal Business Name): MADISON THIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 EGGERT RD STE 1
AMHERST NY
14226-2063
US

IV. Provider business mailing address

824 DELAWARE AVE
BUFFALO NY
14209-2006
US

V. Phone/Fax

Practice location:
  • Phone: 716-218-0780
  • Fax:
Mailing address:
  • Phone: 716-335-7318
  • Fax: 716-884-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number108649
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: