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General NPI Number Information
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NPI Number | 1114792579
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Entity Type | Individual
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Provider Name | ELIZABETH BERTHA MADUGNO LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 440 FURROWS RD
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City | HOLBROOK
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State | NY
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Zip | 11741-2700
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Country | US
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Telephone | 631-645-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 364 HIGH BRIDGE RD
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City | MOUNT UPTON
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State | NY
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Zip | 13809-4186
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Country | US
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Telephone | 607-337-8041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 121259
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License Number State | NY
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