Provider Demographics
NPI:1396083168
Name:MADISON PSYCHIATRIC & PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:MADISON PSYCHIATRIC & PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-663-5926
Mailing Address - Street 1:702 N BLACKHAWK AVE
Mailing Address - Street 2:#100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-663-5926
Mailing Address - Fax:608-663-5928
Practice Address - Street 1:702 N. BLACKHAWK AVE
Practice Address - Street 2:#100
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-663-5926
Practice Address - Fax:608-663-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty