MARY MADRAKE PSY.D
NPI 1710409024
Psychologist - Clinical in Chicago, IL

Q: What is Mary Madrake's NPI number?

The NPI number for Mary Madrake is 1710409024. It was assigned to this individual provider in the NPPES registry on July 10, 2017.

Q: What is Mary Madrake's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Mary Madrake enrolled in Medicare?

No. Mary Madrake has opted out of Medicare through January 30, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Mary Madrake was last updated on October 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 10, 2017Opted out of Medicare · through Jan 30, 2028

3301 W 111TH ST, CHICAGO, IL 60655(312) 469-0486(773) 233-6111 Get Directions Write a Review

NPPES record last updated: October 5, 2021. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Oct 5, 2021, Jul 10, 2017 (2 updates tracked since 2017).

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About Mary Madrake Psy.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY MADRAKE PSY.D (NPI 1710409024) is an individual clinical provider in Chicago, Illinois, licensed in Illinois (071010572) and active in the NPI registry since July 2017. She has opted out of Medicare through January 30, 2028.

NPPES Registry Identity

NPI1710409024

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameMARY MADRAKECredential: PSY.D

Location Address3301 W 111TH STChicago, IL 60655-2715

Mailing Address317 W Calendar Ave Apt 3bLa Grange, IL 60525-2029 · (252) 671-0238

Phone(312) 469-0486

Fax(773) 233-6111

Sole ProprietorNo

Enumeration DateJuly 10, 2017

Last NPPES UpdateOctober 5, 20212 updates tracked since enumeration

NPPES CertifiedOctober 5, 2021

✔ NPI 1710409024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in IL · 071010572

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

3301 W 111TH ST, Chicago, IL 60655

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Mary Madrake Psy.d has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 30, 2024 through January 30, 2028.

Opt-Out Effective DateJanuary 30, 2024

Opt-Out In Effect ThroughJanuary 30, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TANIA VELAZQUEZ

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