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General NPI Number Information
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NPI Number | 1518264886
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Entity Type | Organization
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Legal Business Name | MADISON MARRIAGE AND FAMILY THERAPY, PC
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 271 MADISON AVE STE. 1400
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City | NEW YORK
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State | NY
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Zip | 10016-1001
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Country | US
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Telephone | 646-205-7606
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Fax |
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Provider Business Mailing Address
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Address Line | 271 MADISON AVE STE. 1400
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City | NEW YORK
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State | NY
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Zip | 10016-1001
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Country | US
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Telephone | 646-205-7606
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MELISSA KESTER
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Credential | LMFT
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Telephone | 646-205-7606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 00733
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License Number State | NY
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