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General NPI Number Information
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NPI Number | 1972334621
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Entity Type | Individual
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Provider Name | MADISON MARJORIE REYNIK LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 800 W WILLIAMS ST STE 280
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City | APEX
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State | NC
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Zip | 27502-5203
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Country | US
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Telephone | 919-800-8114
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Fax | 919-355-5694
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Provider Business Mailing Address
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Address Line | 505 GREYFRIARS LN
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City | CARY
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State | NC
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Zip | 27518-8627
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Country | US
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Telephone | 919-608-7738
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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