Provider Demographics
NPI:1033957519
Name:MADAKI, FERDINAND AYELLENAH (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:AYELLENAH
Last Name:MADAKI
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1417
Mailing Address - Country:US
Mailing Address - Phone:631-408-6281
Mailing Address - Fax:
Practice Address - Street 1:25 SECOND AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1417
Practice Address - Country:US
Practice Address - Phone:646-410-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty