Healthcare Provider Details

I. General information

NPI: 1710043195
Provider Name (Legal Business Name): MADALINE BERLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 EAST 55TH ST NE SUITE 5J
NEW YORK NY
10022-4038
US

IV. Provider business mailing address

155 EAST 55TH ST NE SUITE 5J
NEW YORK NY
10022-4038
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-4245
  • Fax: 212-988-3906
Mailing address:
  • Phone: 212-759-4245
  • Fax: 212-759-9908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberR032852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: