MEDICARE: MS. LEILAH R MADORSKY LCSW

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
1	1041C0700X	Clinical Social Worker	LCSW66438	CA

General Provider Information

NPI Number	:	1598911489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEILAH R MADORSKY LCSW

Provider Business Mailing Address
First Line	:	180 NEWPORT CENTER DR STE 158
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-0934
Country	:	US
Telephone Number	:	949-719-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 DOVE ST # 791-7138
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2838
Country	:	US
Telephone Number	:	949-791-7138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	01/21/2022

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