Provider Demographics
NPI:1063733467
Name:DUNN, MADELEINE J (PHD)
Entity type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:J
Last Name:DUNN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 SAN JOSE PL
Mailing Address - Street 2:SUITE 35
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8858
Mailing Address - Country:US
Mailing Address - Phone:904-886-7004
Mailing Address - Fax:
Practice Address - Street 1:3750 SAN JOSE PL
Practice Address - Street 2:SUITE 35
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8858
Practice Address - Country:US
Practice Address - Phone:904-886-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8950103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent