Healthcare Provider Details

I. General information

NPI: 1033921465
Provider Name (Legal Business Name): MADELAINE BUKIET MHC-LP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 5TH AVE FL 5
NEW YORK NY
10001-4527
US

IV. Provider business mailing address

16 ARION PL # 1
BROOKLYN NY
11206-6002
US

V. Phone/Fax

Practice location:
  • Phone: 212-961-9611
  • Fax:
Mailing address:
  • Phone: 212-961-9611
  • 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: