Healthcare Provider Details

I. General information

NPI: 1134008766
Provider Name (Legal Business Name): MADISON HOUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DOBBIN ST
BROOKLYN NY
11222-5502
US

IV. Provider business mailing address

394 PROSPECT AVE APT 1R
BROOKLYN NY
11215-5661
US

V. Phone/Fax

Practice location:
  • Phone: 757-754-2496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: