Provider Demographics
NPI:1386333557
Name:MARIA, MADISON II
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MARIA
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1148
Mailing Address - Country:US
Mailing Address - Phone:781-592-5691
Mailing Address - Fax:
Practice Address - Street 1:121 FRANKLIN ST APT 203
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4164
Practice Address - Country:US
Practice Address - Phone:781-479-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker