Provider Demographics
NPI:1588170955
Name:MADDEN, DEIRDRE ANN (LICSW)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANN
Last Name:MADDEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CABOT ST STE 206
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2819
Mailing Address - Country:US
Mailing Address - Phone:617-244-5552
Mailing Address - Fax:617-795-0589
Practice Address - Street 1:50 CABOT ST STE 206
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2819
Practice Address - Country:US
Practice Address - Phone:617-244-5552
Practice Address - Fax:617-795-0589
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW027521041C0700X
MA1181971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical