Provider Demographics
NPI:1063779536
Name:CRADER, MAEGON (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MAEGON
Middle Name:
Last Name:CRADER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 EAGLEVIEW BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1150
Mailing Address - Country:US
Mailing Address - Phone:610-422-3064
Mailing Address - Fax:484-870-9846
Practice Address - Street 1:397 EAGLEVIEW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1150
Practice Address - Country:US
Practice Address - Phone:610-422-3064
Practice Address - Fax:484-870-9846
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64435101YP2500X
PAPC015868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional