Provider Demographics
NPI:1194847079
Name:MADDOX, DEBRA (PSYD LMHC LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MADDOX
Suffix:
Gender:F
Credentials:PSYD LMHC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COMMERCIAL ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1726
Mailing Address - Country:US
Mailing Address - Phone:508-752-4665
Mailing Address - Fax:508-752-0947
Practice Address - Street 1:250 COMMERCIAL ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1726
Practice Address - Country:US
Practice Address - Phone:508-752-4665
Practice Address - Fax:508-752-0947
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA836101YM0800X
MA4987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1028720OtherNEIGHBORHOOD HEALTH PLAN
MA1030720OtherFALLON
MALM0827OtherBLUE CROSS OF MA
MA1891782OtherMASS HEALTH
MA392209OtherMAGELLAN
MA7674399OtherAETNA