Healthcare Provider Details

I. General information

NPI: 1316656234
Provider Name (Legal Business Name): VIRGINIA ALICE MADDEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA ALICE MADDEN MSW

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST
ONEIDA NY
13421-2111
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3191
US

V. Phone/Fax

Practice location:
  • Phone: 315-280-0400
  • Fax: 315-280-0087
Mailing address:
  • Phone: 77-530-2346
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP103664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: