Basic Information
| Provider Information | |||||||||
| NPI: | 1629210398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADAIO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 NORTH COURT STREET | ||||||||
| Address2: | |||||||||
| City: | WAMPSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153662755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134212111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153618413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 03/27/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1689780546 | 05 | NY | MEDICAID |