Healthcare Provider Details

I. General information

NPI: 1063652691
Provider Name (Legal Business Name): MADELEINE SHAIR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 RESERVOIR OVAL SCHOOL BASED HEALTH CENTER
BRONX NY
10467-3101
US

IV. Provider business mailing address

7 MINOR CT
WEST NYACK NY
10994-1110
US

V. Phone/Fax

Practice location:
  • Phone: 718-696-4060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: