Individual
MICHELLE MADRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COUNSELOR
Contact information
Practice address
21 OLD ROUTE 6, CARMEL, NY 10512-2107
(845) 225-5202
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4523
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36131
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC-6515
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420795
—
NY
Enumeration date
11/11/2019
Last updated
11/26/2019
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