MEDICARE: MADISON PALADINO BSW MSW LCSW-A

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	P019805	NC

General Provider Information

NPI Number	:	1740057058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON PALADINO BSW MSW LCSW-A

Provider Business Mailing Address
First Line	:	1625 S 17TH ST APT 233
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-6563
Country	:	US
Telephone Number	:	704-724-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 MERCHANTS CIR STE 100
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-5279
Country	:	US
Telephone Number	:	704-724-7442
Fax Number	:

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

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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