Provider Demographics
NPI:1285456319
Name:LECAINE, MADONNA MICHELLE (RADT)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:MICHELLE
Last Name:LECAINE
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 COGSWELL RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-2785
Mailing Address - Country:US
Mailing Address - Phone:626-453-3417
Mailing Address - Fax:
Practice Address - Street 1:3430 COGSWELL RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2785
Practice Address - Country:US
Practice Address - Phone:626-453-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1552330324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)