Madalyn Marie Derrick, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C018606 Issued in NC

Practice address

8206 Village Harbor Dr
Cornelius, NC 28031-3706

Phone

(407) 803-2390

NPI assigned

Jun 23, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Madalyn Marie Kostur Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Solstice Child and Family Wellness PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Charlotte, NC
  • NPI 1134943848
  NPD Authorized official
• Caladrius Therapy, PLLC

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1922657873
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1174254619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8206 VILLAGE HARBOR DR",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280313706",
            "telephone_number": "407-803-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8206 VILLAGE HARBOR DR",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280313706",
            "telephone_number": "407-803-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "MADALYN",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017676",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C018606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADALYN",
            "last_name": "KOSTUR",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine A Debree, PT
• Nancy Elizabeth Deem, FNP
• Matt Deeringer, MED, ATC
• Nicole Degner, MSPT
• Amy Der
• Suresh Jayantha Desilva, MD
• Stacey E Devine, M.D.
• Diabetic Special Care
• Diabetic Supply Institute Inc
• Diabetic Support Services, Inc.

• Clinical Social Worker in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.