Provider Demographics
NPI:1104048164
Name:MADER, MARGIE (LMFT, CHT)
Entity type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:
Last Name:MADER
Suffix:
Gender:F
Credentials:LMFT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WEST CYPRESS CREEK ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-491-2079
Mailing Address - Fax:954-776-2756
Practice Address - Street 1:2400 WEST CYPRESS CREEK ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309
Practice Address - Country:US
Practice Address - Phone:954-491-2079
Practice Address - Fax:954-776-2756
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1720103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy