Healthcare Provider Details

I. General information

NPI: 1831014802
Provider Name (Legal Business Name): NICOLE J MADOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 DANTE CT
HOLBROOK NY
11741-3839
US

IV. Provider business mailing address

278 N 5TH ST
LINDENHURST NY
11757-3732
US

V. Phone/Fax

Practice location:
  • Phone: 631-590-0776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: