Provider Demographics
NPI:1003785791
Name:BRISENDINE, MADELINE CLAIRE (CD, NCS, LES)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:CLAIRE
Last Name:BRISENDINE
Suffix:
Gender:F
Credentials:CD, NCS, LES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 LOCKSLEY PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2731
Mailing Address - Country:US
Mailing Address - Phone:410-340-7774
Mailing Address - Fax:
Practice Address - Street 1:2616 LOCKSLEY PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2731
Practice Address - Country:US
Practice Address - Phone:410-340-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula