Provider Demographics
NPI:1174229009
Name:BEITZ, MADELEINE (LMSW)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:BEITZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 8TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2612
Mailing Address - Country:US
Mailing Address - Phone:215-668-5420
Mailing Address - Fax:
Practice Address - Street 1:202 8TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2612
Practice Address - Country:US
Practice Address - Phone:215-668-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115954-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker