1609561612 NPI number — MRS. MADALYN ESTHER CONETTA LCSW

Table of content: MRS. MADALYN ESTHER CONETTA LCSW (NPI 1609561612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609561612 NPI number — MRS. MADALYN ESTHER CONETTA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONETTA
Provider First Name:
MADALYN
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALDONADO
Provider Other First Name:
MADALYN
Provider Other Middle Name:
ESTHER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609561612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 CAPITAL CIR SE STE 18230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32301-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-583-1903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 N GADSDEN ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32301-7615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-583-1903
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW11174 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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