Provider Demographics
NPI:1720809668
Name:SIDOFF, MADELEINE VICTORIA (LPC-A)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:VICTORIA
Last Name:SIDOFF
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 THE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:THE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1337
Mailing Address - Country:US
Mailing Address - Phone:847-668-4028
Mailing Address - Fax:
Practice Address - Street 1:206 THE HILLS DR
Practice Address - Street 2:
Practice Address - City:THE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78738-1337
Practice Address - Country:US
Practice Address - Phone:847-668-4028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health