Provider Demographics
NPI:1316656234
Name:MADDEN, VIRGINIA ALICE (MSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ALICE
Last Name:MADDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ALICE
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:165 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3191
Mailing Address - Country:US
Mailing Address - Phone:077-530-2346
Mailing Address - Fax:607-753-0286
Practice Address - Street 1:201 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2111
Practice Address - Country:US
Practice Address - Phone:315-280-0400
Practice Address - Fax:315-280-0087
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103664101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1041C0700XOtherTAXONOMY