1346266582 NPI number — DOLORES MADIOU LCSW-C

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346266582 NPI number — DOLORES MADIOU LCSW-C

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MADIOU

Provider First Name:

DOLORES

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

LCSW-C

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1346266582

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/22/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

4623 FALLS RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BALTIMORE

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21209-4914

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-366-1980

Provider Business Mailing Address Fax Number:

410-366-8530

Provider First Line Business Practice Location Address:

10451 TWIN RIVERS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COLUMBIA

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21044-2388

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-997-3557

Provider Business Practice Location Address Fax Number:

410-964-1791

Provider Enumeration Date:

07/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  01262 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 399170 . This is a "TRICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 226092 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 239330-000 . This is a "MAGELLAN HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: PVP134855 . This is a "APS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7618409 . This is a "AETNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 280361 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 417290 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 492610200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 11249314 . This is a "CAQH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: T541 0025 . This is a "BCBS-DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".