Provider Demographics
NPI:1225527435
Name:MADZIAREK, CONNIE MARIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:MADZIAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:MARIE
Other - Last Name:PARASKEVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 N. HIGHWAY 160 PAHRUMP, NV 89060
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060
Mailing Address - Country:US
Mailing Address - Phone:775-505-1625
Mailing Address - Fax:
Practice Address - Street 1:2050 N. HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89069
Practice Address - Country:US
Practice Address - Phone:775-505-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)