Provider Demographics
NPI:1932128600
Name:MADONIA, MICHAEL J (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MADONIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 ELIOT RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3033
Mailing Address - Country:US
Mailing Address - Phone:412-512-1604
Mailing Address - Fax:
Practice Address - Street 1:1373 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2503
Practice Address - Country:US
Practice Address - Phone:412-512-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA731242Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N