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NPI Code Detail

MEDICARE: MADELEINE SHORE

MEDICARE: MADELEINE SHORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor10986CA

General Provider Information

NPI Number : 1447902317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELEINE SHORE
Provider Business Mailing Address
First Line : 7046 CREBS AVE
Second Line :
City : RESEDA
State : CA
Zip : 91335-4024
Country : US
Telephone Number : 615-415-0187
Fax Number :
Provider Business Practice Location Address
First Line : 11845 W OLYMPIC BLVD STE 1050W
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-5046
Country : US
Telephone Number : 424-330-2217
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2022
Last Update Date : 02/13/2023

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Directions to “ MADELEINE SHORE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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