Provider Demographics
NPI:1659120095
Name:VIELMANN, MADELINE G (LICSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:G
Last Name:VIELMANN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BOSTON AVE STE 1925
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4243
Mailing Address - Country:US
Mailing Address - Phone:617-533-0416
Mailing Address - Fax:
Practice Address - Street 1:200 BOSTON AVE STE 1925
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4243
Practice Address - Country:US
Practice Address - Phone:617-533-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW11205141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical