Provider Demographics
NPI:1346354636
Name:MCFADDEN, MATHEW EDWARD (PSYD, LCPC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:EDWARD
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 JAMES ST STE 8
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2174
Mailing Address - Country:US
Mailing Address - Phone:630-429-7852
Mailing Address - Fax:630-385-0150
Practice Address - Street 1:515 JAMES ST STE 8
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2174
Practice Address - Country:US
Practice Address - Phone:630-429-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0101051101YP2500X
IL180003400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002225381OtherBLUE CROSS BLUE SHIELD