Provider Demographics
NPI:1609441732
Name:ROSALES, MADYSAN (LCSWA)
Entity type:Individual
Prefix:
First Name:MADYSAN
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:MADYSAN
Other - Middle Name:
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:327 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6122
Mailing Address - Country:US
Mailing Address - Phone:828-695-5900
Mailing Address - Fax:828-695-4256
Practice Address - Street 1:327 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6122
Practice Address - Country:US
Practice Address - Phone:828-695-5900
Practice Address - Fax:828-695-4256
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0194381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician