MEDICARE: MADALYN HARVEY BERENDT

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	6801106995	MI
2	104100000X	Social Worker	6801102191

General Provider Information

NPI Number	:	1992240352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADALYN HARVEY BERENDT

Provider Business Mailing Address
First Line	:	2046 WASHTENAW RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1706
Country	:	US
Telephone Number	:	734-768-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2046 WASHTENAW RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1706
Country	:	US
Telephone Number	:	734-768-0968
Fax Number	:

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

Provider Enumeration Date	:	12/21/2016
Last Update Date	:	12/16/2025

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Directions to “ MADALYN HARVEY BERENDT ” Practice Location

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